HCPCS L6975: Interscapular-Thoracic Myoelectric Upper-Extremity Prosthesis - OpenPayer

Summary & Overview

HCPCS L6975: Interscapular-Thoracic Myoelectric Upper-Extremity Prosthesis

HCPCS Level II code L6975 represents an externally powered interscapular-thoracic myoelectric upper-extremity prosthesis with a molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, electrodes, cables, batteries, charger, and myoelectronic control of the terminal device. This code captures a complex, component-rich prosthetic system used for high-level upper-limb amputations or congenital limb differences requiring an interscapular-thoracic design. Nationally, such devices are important for restoring functional independence and enabling activities of daily living for patients with proximal upper-limb loss.

Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what L6975 covers clinically and operationally, guidance on typical sites of service, and a summary of common billing modifiers used with similar durable medical equipment claims. The publication also outlines expected documentation elements, the clinical context for appropriate use, and where to look for payer-specific coverage policies. Data not available in the input: specific associated taxonomies, ICD-10 diagnoses, related codes, and service-line revenue details.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL6975HCPCS Level IIupper extremity prosthesismyoelectric prosthesisprosthetics and orthoticsdurable medical equipmentinterscapular-thoracic prosthesis

Billing Code Overview

HCPCS Level II code L6975 describes an interscapular-thoracic, externally powered upper-extremity prosthetic system. The full description specifies a molded inner socket with a removable shoulder shell and shoulder bulkhead, a humeral section with a mechanical elbow and forearm, plus myoelectronic control of the terminal device. The listed components include electrodes, cables, two batteries, and one charger; the description cites an example manufacturer (Otto Bock) or equivalent.

Service Type: Prosthetic device provision and fitting (externally powered myoelectric upper-extremity prosthesis)

Typical Site of Service: Prosthetics/orthotics clinic, specialized rehabilitation facility, or hospital outpatient prosthetics department

Clinical & Coding Specifications

Clinical Context

A 45-year-old right-hand dominant patient with a traumatic transhumeral amputation presents to a regional prosthetics and orthotics clinic for provision of an externally powered interscapular-thoracic prosthesis. The prescription indicates a molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, myoelectronic-controlled terminal device with electrodes, cables, two batteries and one charger. The clinical workflow begins with a multidisciplinary prosthetic evaluation (physiatry, prosthetist, occupational therapy) to document functional goals, limb anatomy, and skin condition. A custom casting or digital scan is obtained for the molded inner socket. A trial fitting confirms suspension and shoulder shell fit; adjustments are made to the shoulder bulkhead and humeral section to optimize range of motion and comfort. Myoelectric electrode placement is tested on residual musculature, and training sessions with occupational therapy teach control strategies and device care. Final delivery includes device programming, battery education, and documentation of medical necessity, functional outcome measures, and device component inventory. Follow-up visits address fit adjustments, component repair or replacement, and progressive training needs.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier specified (default)	Use when no specific modifier applies to the claim.

HCPCS L6704: Terminal Device for Sport/Recreational/Work Attachment

HCPCS-L6930-BELOW-ELBOW-EXTERNAL-POWER-PROSTHESIS-SELF-SUSPENDED-SOCKET

HCPCS L6930: Below-Elbow External Power Forearm Prosthesis

HCPCS-L7401-UPPER-EXTREMITY-PROSTHESIS-ABOVE-ELBOW-ULTRALIGHT

HCPCS L7401: Addition to Above-Elbow Prosthesis, Ultralight Material

HCPCS-L7367-LITHIUM-ION-RECHARGEABLE-BATTERY-REPLACEMENT

HCPCS L7367: Lithium Ion Battery, Rechargeable, Replacement

HCPCS-L7008-ELECTRIC-PEDIATRIC-MYOELECTRIC-SWITCH-HAND

HCPCS L7008: Electric Pediatric Hand, Switch or Myoelectric Controlled

HCPCS-L8680-IMPLANTABLE-NEUROSTIMULATOR-ELECTRODE

HCPCS L8680: Implantable Neurostimulator Electrode

HCPCS-L6028-PARTIAL-HAND-FINGER-THUMB-PROSTHESIS-METACARPAL-LEVEL

HCPCS L6028: Partial Hand/Finger/Thumb Prosthesis, Metacarpal Level

HCPCS-L6905-PARTIAL-HAND-RESTORATION-WITH-GLOVE-MULTIPLE-FINGERS

HCPCS L6905: Hand Restoration, Partial Hand with Glove, Multiple Fingers Remaining

HCPCS-L7185-ELECTRONIC-ELBOW-ADOLESCENT-SWITCH-CONTROLLED

HCPCS L7185: Electronic Elbow Orthosis, Adolescent, Switch-Controlled

HCPCS-L7362-BATTERY-CHARGER-6-VOLT-DME-ACCESSORY

HCPCS Level II L7362: Battery Charger, Six Volt

Showing 1–10 of 472

Taxonomy Code	Specialty	Notes
`261QR0400X`	Prosthetics and Orthotics	Primary provider specialty for device fabrication and fitting.
`2084P0800X`	Physical Medicine & Rehabilitation (Physiatry)	Clinical oversight, medical necessity documentation, functional assessment.
`251B00000X`	Occupational Therapy	Device training, ADL assessment, myoelectric control training.
`207RH0000X`	Physical Therapy	Assistive device training and functional mobility support.
`207L00000X`	Orthopedic Surgery	Surgical management of residual limb or revisions that affect prosthetic interface.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S48.011A`	Complete traumatic amputation of right humerus, initial encounter	Common indication for an interscapular-thoracic external power prosthesis when amputation is proximal.
`S48.012A`	Complete traumatic amputation of left humerus, initial encounter	As above for left-sided proximal upper extremity amputations.
`S48.091A`	Traumatic amputation of unspecified level of right upper arm, initial encounter	Alternative trauma code when level is not otherwise specified.
`Z89.611`	Acquired absence of right arm above elbow	Used for established amputees requiring prosthetic replacement or revision.
`Z89.612`	Acquired absence of left arm above elbow	Used for established left-sided above-elbow amputees needing prosthesis.
`G54.0`	Brachial plexus injury	May result in nonfunctional limb or limb loss requiring prosthetic rehabilitation.
`T87.89`	Complications of other procedures, not elsewhere classified	Used for complications related to residual limb or prior prosthetic fittings when relevant.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic management and training, upper extremity, initial encounter	Used for training the patient in use, donning/doffing, and function of the myoelectric prosthesis after delivery.
`97763`	Orthotic/prosthetic management and training, each additional encounter	Used for follow-up training sessions to refine control and function.
`97750`	Physical performance test or measurement	Used to document baseline and outcome functional measures pre- and post-prosthesis fitting.
`99456`	Work-related or medical disability examination	Used when prosthesis provision requires work-related functional capacity documentation (note: code selection depends on payer-required exam type).
`99070`	Supplies and materials (unlisted items)	Used rarely to bill for additional non-standard accessories or expendable supplies associated with prosthesis delivery.

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