L7045 Electric Pediatric Myoelectric Hook Reimbursement | OpenPayer

Summary & Overview

HCPCS L7045: Electric Pediatric Myoelectric Hook

Headline: HCPCS Level II code L7045 covers pediatric electric or myoelectric prosthetic hooks

HCPCS Level II code L7045 designates an electric hook, switch- or myoelectric-controlled, for pediatric prosthetic use. This code captures a powered terminal device used in pediatric upper-extremity prostheses, relevant to clinicians, prosthetists, and payers nationwide because of its implications for clinical functionality, device classification, and coverage determination.

Major national payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for pediatric powered terminal devices, typical sites of service where fittings and follow-up occur, and the kinds of coverage considerations payers address for powered prosthetic components.

The publication provides benchmarks and patterns relevant to utilization and reimbursement, summarizes common billing practices and applicable modifiers (where available), and highlights policy updates that affect coding and claim adjudication for powered pediatric terminal devices. Clinical context explains functional indications for electric or myoelectric hooks and how they differ from passive or body-powered alternatives. Data not available in the input will be identified explicitly. The content is intended to inform billing professionals, prosthetic providers, and policy analysts about coding, clinical application, and payer coverage considerations for L7045 at a national level.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareL7045HCPCS Level IIpediatric prostheticsmyoelectricelectric hookprosthetic terminal devicebillingoutpatient rehabilitation

Billing Code Overview

HCPCS Level II code L7045 describes an electric hook, switch or myoelectric controlled, pediatric prosthetic component. This device is a powered terminal device intended for pediatric patients and is controlled either by an electrical switch or myoelectric signals from residual musculature.

Service type: Prosthetic component, powered terminal device for pediatric upper-extremity prosthesis
Typical site of service: Orthotics and prosthetics clinic, specialized pediatric prosthetics centers, or outpatient rehabilitation settings

Clinical & Coding Specifications

Clinical Context

A pediatric patient with congenital upper-limb limb deficiency or acquired amputation is being fitted with an external prosthetic terminal device: an electrically powered hook under myoelectric or switch control. Typical candidate is a child aged 2–16 years with unilateral transradial amputation or congenital transverse deficiency who has sufficient residual musculature to generate myoelectric signals or for whom externally actuated switches are appropriate. The clinical workflow includes: initial prosthetic and occupational therapy evaluation, measurement and casting or digital scanning of the residual limb, selection of an electric hook terminal device (L7045) with appropriate control system (single-site myoelectric or externally mounted switch), fabrication and assembly by a certified prosthetist, initial fitting and alignment in the prosthetics clinic, training with occupational therapy for donning/doffing, control training, and periodic follow-up visits for adjustment and growth-related socket refitting. Typical sites of service are outpatient prosthetics clinics, pediatric rehabilitation centers, and ambulatory surgery centers for complex fittings or revisions when adjustments cannot be completed in clinic.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the professional component of a service related to prosthetic prescription or fitting performed by a clinician separate from the supplier.

HCPCS L7364: Twelve Volt Battery, Durable Medical Equipment

HCPCS-L8044-HEMI-FACIAL-PROSTHESIS-NON-PHYSICIAN

HCPCS Level II L8044: Hemi-facial Prosthesis, Non-Physician

HCPCS-L8514-TRACHEOESOPHAGEAL-PUNCTURE-DILATOR-REPLACEMENT

HCPCS L8514: Tracheoesophageal Puncture Dilator, Replacement Only, Each

HCPCS-L8687-IMPLANTABLE-NEUROSTIMULATOR-RECHARGEABLE-DUAL-ARRAY

HCPCS L8687: Implantable Rechargeable Neurostimulator Pulse Generator, Dual Array

HCPCS-L7402-UPPER-EXTREMITY-PROSTHESIS-SHOULDER-DISARTICULATION-ULTRALIGHT

HCPCS L7402: Addition to Upper Extremity Prosthesis, Shoulder Disarticulation

HCPCS-L5642-ADDITION-LOWER-EXTREMITY-ABOVE-KNEE-LEATHER-SOCKET

HCPCS L5642: Addition to Lower Extremity, Above Knee, Leather Socket

HCPCS-L8605-ANAL-CANAL-BULKING-AGENT-DEXTRANOMER-HYALURONIC-ACID

HCPCS Level II L8605: Anal Canal Injectable Bulking Agent

HCPCS-L5790-ABOVE-KNEE-EXOSKELETAL-ULTRA-LIGHT-ADDITION

HCPCS L5790: Above-Knee Exoskeletal Prosthetic Addition, Ultra-Light Material

HCPCS-L5500-INITIAL-BELOW-KNEE-PTB-SOCKET-SACH-FOOT

HCPCS L5500: Initial Below-Knee PTB Socket with SACH Foot

HCPCS-L6400-BELOW-ELBOW-MOLDED-SOCKET-ENDOSKELETAL

HCPCS L6400: Below-Elbow Molded Socket, Endoskeletal System

Showing 1–10 of 472

Taxonomy Code	Specialty	Notes
`2084P0800X`	Pediatric Physical Medicine & Rehabilitation Physician	Often directs prosthetic prescriptions, functional assessments, and rehabilitation planning.
`225700000X`	Occupational Therapist	Provides training in prosthetic control, ADL retraining, and functional outcome measurement.
`333600000X`	Orthotist/Prosthetist	Clinician responsible for device selection, fabrication oversight, fitting, and adjustments.
`231H00000X`	Pediatrician	Coordinates overall pediatric care and developmental considerations for device use.
`208000000X`	Plastic Surgeon	May be involved when residual limb revision or soft-tissue procedures are required prior to definitive prosthetic fitting.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q71.3`	Congenital absence of forearm and hand	Common congenital indication for fitting a pediatric electric terminal device such as `L7045`.
`Q73.0`	Amelia, upper limb	Pediatric congenital limb absence requiring prosthetic replacement and functional training.
`S48.091A`	Strain of muscle, fascia and tendon at shoulder and upper arm level, initial encounter	Acute traumatic injuries in children that can lead to partial limb loss or significant functional impairment prompting prosthetic consideration.
`S58.031A`	Traumatic amputation of right forearm, initial encounter	Direct indication for a myoelectric or switch-controlled pediatric terminal device for restoration of function.
`S58.032A`	Traumatic amputation of left forearm, initial encounter	As above, left-side laterality for device designation such as `UE`.
`Z89.612`	Acquired absence of right forearm and hand	Post-amputation status that supports prosthetic provision including an electric hook.
`Z89.611`	Acquired absence of left forearm and hand	As above for left-sided prosthetic device fitting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97760`	Orthotic and prosthetic management and training, upper extremity, initial fitting and training, per limb, per session	Used for occupational therapy sessions for training a pediatric patient in use of an electric hook prosthesis (`L7045`).
`97763`	Orthotic and prosthetic follow-up management, upper extremity, established patient, per visit	Used for routine follow-up visits to adjust control settings, alignment, and to assess function.
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or procedure	Used when additional disposables, replacement parts, or specialized electrodes/switch components for the electric hook are provided during a visit.
`L-codes`	Description not applicable — CPT vs HCPCS distinction	Data not applicable; device itself is billed with HCPCS `L7045` as a durable medical equipment/prosthesis code.
`11042`	Debridement, subcutaneous tissue — Description provided for surgical context only	Used when minor surgical procedures on the residual limb are required prior to prosthetic fitting; billed by surgeons when performed.

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