Question 1

What is HCPCS code L6965?

Accepted Answer

HCPCS code L6965 is "Shldr disartic myoelectronic". Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device

Question 2

What category is L6965 in?

Accepted Answer

L6965 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L6965?

Accepted Answer

Use L6965 when billing for shldr disartic myoelectronic. 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 L6965 covered by Medicare?

Accepted Answer

Coverage for L6965 (Shldr disartic myoelectronic) 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 L6965?

Accepted Answer

Documentation for L6965 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).