Question 1

What is HCPCS code L8631?

Accepted Answer

HCPCS code L8631 is "Mcp joint repl 2 pc or more". Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)

Question 2

What category is L8631 in?

Accepted Answer

L8631 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L8631?

Accepted Answer

Use L8631 when billing for mcp joint repl 2 pc or more. 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 L8631 covered by Medicare?

Accepted Answer

Coverage for L8631 (Mcp joint repl 2 pc or more) 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 L8631?

Accepted Answer

Documentation for L8631 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).