Question 1

What is HCPCS code L6960?

Accepted Answer

HCPCS code L6960 is "Shldr disartic switch contro". Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal switch, cables, two batteries and one charger, switch control of terminal device

Question 2

What category is L6960 in?

Accepted Answer

L6960 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L6960?

Accepted Answer

Use L6960 when billing for shldr disartic switch contro. 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 L6960 covered by Medicare?

Accepted Answer

Coverage for L6960 (Shldr disartic switch contro) 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 L6960?

Accepted Answer

Documentation for L6960 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).