CMS Finalizes Reimbursement Rates for Partial Hand Prosthetic Codes

What You Need to Know

In November, the HCPCS Coding Workgroup published preliminary proposed rates for twelve new partial hand prosthetic codes. The following month, several subject matter experts presented at a public meeting and written comments were submitted to CMS in hopes of influencing the final payment decisions. Despite these efforts, the rates finalized by CMS are largely unchanged from the mid-November proposal.

There were a few notable outcomes:

• A minor win with the digit and thumb terminal device codes (L6035/L6036): The rate increased from the proposed $280 to $1,591 — a meaningful improvement, though far below what advocates had hoped for.
• Partial hand socket add-on codes have been priced at the same reimbursement rate as the equivalent transradial codes.
• Multiaxial/rotation/abduction-adduction mechanism code: The rate increased from $64.22 to $364.48.

Code -- Avg Medicare Reimb. -- Description

L6028 -- $1,944.02 -- Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at metacarpal level, including flexible or non-flexible interface, molded to patient model, including palm, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by L6692

L6029 -- $332.06 -- Upper extremity addition, test socket/interface, partial hand including fingers

L6030 -- $751.19 -- Upper extremity addition, external frame, partial hand including fingers

L6031 -- $1,585.87 -- Replacement socket/interface, partial hand including fingers, molded to patient model, for use with or without external power

L6032 -- $375.52 -- Addition to upper extremity prosthesis, partial hand including fingers, ultralight material (titanium, carbon fiber or equal)

L6033 -- $451.20 -- Addition to upper extremity prosthesis, partial hand including fingers, acrylic material

L6034 -- $388.80 -- Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at distal to metacarpal joint, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692

L6035 -- $1,591.25 -- Single prosthetic digit, mechanical, can include metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement

L6036 -- $1,591.25 -- Prosthetic thumb, mechanical, can include metacarpophalangeal (mcp), interphalangeal (ip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement

L6037 -- $1,583.09 -- Immediate post-surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, partial hand including fingers

L6038 -- $364.48 -- Addition to single prosthetic digit or thumb, mechanical, attachment, multiaxial and/or internal/external rotation/abduction/adduction mechanism, with or without locking feature, any material

L6039 -- $2,106.26 -- Passive prosthetic digit or thumb prosthesis not including hand restoration partial hand, full or partial, custom made, any material, initial or replacement, per single passive prosthetic digit or thumb

What This Means for You

The finalized rates present significant challenges for practitioners providing mechanical hand solutions to partial hand amputees. While the increase to the digit and thumb codes is a step in the right direction, the overall pricing structure does not yet reflect the true clinical value and complexity of partial hand prosthetic care. Medicare rates take effect April 1, and we anticipate other payers will be updating their fee schedules shortly after. As those updates roll out, be sure to review your contracts and verify that these codes are recognized and reimbursable by your payers.

To read the full article, click here: CMS HCPCS Level II Final Coding, Benefit Category, and Payment Determinations_B2,2025