Question 1

What is HCPCS code L6694?

Accepted Answer

HCPCS code L6694 is "Elbow socket ins use w/lock". Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, for use with locking mechanism

Question 2

What category is L6694 in?

Accepted Answer

L6694 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L6694?

Accepted Answer

Use L6694 when billing for elbow socket ins use w/lock. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L6694 covered by Medicare?

Accepted Answer

Coverage for L6694 (Elbow socket ins use w/lock) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L6694?

Accepted Answer

Documentation for L6694 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).