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    v1.0.28
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l7185-electronic-elbow-adolescent-switch-controlled
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    HCPCS L7185: Electronic Elbow, Adolescent, Switch Controlled

    HCPCS Level II code L7185 describes an electronic elbow for adolescent patients with a switch control intended as a prosthetic/elbow joint component; the service involves provision and fitting of an externally powered elbow device sized for adolescents and is typically delivered in an outpatient prosthetics/orthotics clinic or durable medical equipment setting where device assembly, adjustment, and patient training occur.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria — Lymphedema Therapy and Training (Complete Decongestive Therapy; LVA), Therapy Services — Electric Stimulation for Pain, Swelling and Function in a Clinic Setting, Site of Care: Outpatient Hospital Setting for Physical and Occupational Therapy.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 14-year-old adolescent with a congenital elbow deficiency presents to a pediatric orthotics clinic for provision of an electronic elbow orthosis L7185 (electronic elbow, adolescent, variety village or equal, switch controlled). The patient demonstrates limited active elbow flexion and extension from a neuromuscular condition and requires an externally powered orthosis with a manual switch control to assist in activities of daily living such as feeding and grooming. The clinical workflow includes: initial evaluation by a pediatric orthotist and orthopedic or physiatry provider, measurement and casting or scanning of the limb, selection and configuration of the electronic elbow unit with switch control, fabrication and fitting session, device tuning and training with the patient and caregiver, and follow-up visits for adjustments, donning/doffing education, and maintenance verification. Typical sites of service include an outpatient orthotics/prosthetics clinic, pediatric rehabilitation center, or hospital-based orthotics department. Insurance coordination typically involves medical necessity documentation, detailed itemized quotes, prior authorization when required, and modifier usage to indicate care circumstances or bilateral/technical splits when applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    97760Orthotic(s) management and training, upper extremity, initial fitting and educationUsed for initial training and education provided by therapy professionals when the electronic elbow L7185 is delivered and fitted.
    97763Orthotic/prosthetic management and training, each 15 minutes, initial encounterBilled for ongoing training sessions and functional use instruction following fitting of L7185.
    99070Supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visitUsed when additional non-standard supplies or replacement parts for the electronic elbow are provided during an office visit.
    97530Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance)Used when occupational or physical therapy integrates the device into task-specific functional therapy sessions.
    95831Muscle testing manual (separate muscle group)Applied during assessment to document baseline elbow/upper extremity strength relevant to fitting and device selection.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    333600000XPharmacyA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    364S00000XClinical Nurse SpecialistA registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
    171M00000XCase Manager/Care CoordinatorA person who provides case management services and assists an individual in gaining access to needed medical, social, educational, and/or other servic…
    2085R0205XRadiological Physics PhysicianA radiological physicist deals with the diagnostic and therapeutic applications of roentgen rays, gamma rays from sealed sources, ultrasonic radiation…
    207N00000XDermatology PhysicianA dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genital…

    Related ICD-10-CM Codes

    16 rows

    ICD-10-CM CodeDescription
    G56.01Carpal tunnel syndrome, right upper limb
    G56.02Carpal tunnel syndrome, left upper limb
    G56.03Carpal tunnel syndrome, bilateral upper limbs
    G56.11Other lesions of median nerve, right upper limb
    G56.12Other lesions of median nerve, left upper limb
    G56.13Other lesions of median nerve, bilateral upper limbs
    M25.541Pain in joints of right hand
    M25.542Pain in joints of left hand
    M75.121Complete rotator cuff tear or rupture of right shoulder, not specified as traumatic
    M75.122Complete rotator cuff tear or rupture of left shoulder, not specified as traumatic

    Showing 1–10 of 16

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    3 rows

    PolicyPayerEffective Date
    Clinical Review Criteria — Lymphedema Therapy and Training (Complete Decongestive Therapy; LVA)Kaiser Permanente2026-09-01
    Therapy Services — Electric Stimulation for Pain, Swelling and Function in a Clinic SettingCigna2026-08-15
    Site of Care: Outpatient Hospital Setting for Physical and Occupational TherapyCigna2026-08-15

    Related Codes

    HCPCS-L5000-PARTIAL-FOOT-SHOE-INSERT-LONGITUDINAL-ARCH-TOE-FILLER

    HCPCS Level II L5000: Partial Foot Shoe Insert with Longitudinal Arch, Toe Filler

    HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

    HCPCS L5010: Partial Foot Molded Socket, Ankle Height, With Toe Filler

    HCPCS-L5020-PARTIAL-FOOT-MOLDED-SOCKET-TIBIAL-TUBERCLE-TOE-FILLER

    HCPCS L5020: Partial Foot Molded Socket with Toe Filler

    HCPCS-L5050-ANKLE-SYMES-MOLDED-SOCKET-SACH-FOOT

    HCPCS L5050: Ankle/Symes Molded Socket with SACH Foot

    HCPCS-L5060-ANKLE-SYMES-METAL-FRAME-MOLDED-LEATHER-SOCKET-ARTICULATED-ANKLE-FOOT

    HCPCS L5060: Ankle/Symes Metal Frame with Molded Leather Socket

    HCPCS-L5100-BELOW-KNEE-MOLDED-SOCKET-SHIN-SACH-FOOT

    HCPCS Level II L5100: Below-Knee Molded Socket with Shin and SACH Foot

    HCPCS-L5105-BELOW-KNEE-PLASTIC-SOCKET-SACH-FOOT

    HCPCS L5105: Below-Knee Plastic Socket Prosthesis with SACH Foot

    HCPCS-L5150-KNEE-DISARTICULATION-MOLDED-SOCKET-EXTERNAL-KNEE-SACH-FOOT

    HCPCS L5150: Knee Disarticulation Molded Socket with External Knee and SACH Foot

    HCPCS-L5160-KNEE-DISARTICULATION-MOLDED-SOCKET-BENT-KNEE-SACH-FOOT

    HCPCS Level II L5160: Knee Disarticulation Molded Socket, Bent Knee Configuration

    HCPCS-L5200-ABOVE-KNEE-MOLDED-SOCKET-SINGLE-AXIS-KNEE-SACH-FOOT

    HCPCS Level II L5200: Above-knee Prosthesis with Molded Socket and Single-axis Knee

    Showing 1–10 of 472

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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