Revised Coding Guidance for Upper Limb
The DME MACs recently published two revised “Correct Coding” articles related to upper limb prostheses, highlighting important updates and reminders for proper billing.
What You Need to Know
In the Correct Coding article for partial hand prostheses, the DME MACs confirmed that the new partial hand base code L6028 will be invalid for billing to Medicare starting October 1, 2025. The existing partial hand HCPCS codes L6000, L6010, and L6020 will remain valid and billable until the revised L6028 code is reintroduced as a valid code for Medicare. These mechanical partial hand base codes cannot be billed with addition codes specific to amputation levels proximal to the partial hand level. The DME MACs also clarify that it is inappropriate to bill L7499 when a specific L-code exists that describes the prosthesis or its features.
In the Correct Coding article for custom fabricated terminal device gloves, the DME MACs clarify that providers cannot bill L7499 for cosmetic features. These enhancements are already included when billing L6895 because the code descriptor states “any material, custom fabricated.” The DME MACs also mentioned that suppliers can request a new HCPCS code through CMS if they believe L6895 should not include these features.
What This Means for You
For any claims with a date of service on or after October 1, 2025, you cannot use code L6028 to bill for a partial hand prosthesis to Medicare. Instead, the only available mechanical partial hand base codes are L6000, L6010, and L6020. Based on the most recent HCPCS coding decisions from CMS, this is only a temporary policy. We anticipate CMS will delete these obsolete base codes and reintroduce L6028 again in April 2026. To ensure accurate billing, you should only bill these base codes with partial hand addition codes and/or upper limb codes that do not specify amputation level. The use of below-elbow addition codes with partial hand base codes will be denied as improper coding.
The DME MACs also make it clear that you cannot bill L7499 for any additional features that are already described by existing HCPCS codes. For example, because the L6895 code narrative mentions “any material,” it includes materials with cosmetic enhancements. Therefore, when billing for a custom terminal device glove, it is not appropriate to bill separately for cosmetic features such as skin tone, hair, veins, and wrinkles.
These updates clarify the proper use of certain upper extremity prosthetic codes. Following this guidance keeps your billing compliant and protects reimbursement for you and your patients. Use the links below to review the complete joint DME MAC publications. You can also contact the PDAC or your local DME MAC directly for further clarification on correct coding practices.
Correct Coding - Partial Hand Prostheses - Revised
Correct Billing for Upper Limb Prosthesis with L6895 instead of L7499 - Revised