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L6035 — Single prosthetic digit, mechanical, can include metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement

HCPCS Level II L-code · short descriptor: “Prosthetic digit mechanical”

Code system
HCPCS Level II
Family
L — Orthotics & prosthetics
Medicare coverage status
Carrier judgment — coverage decided by the DME MAC
DMEPOS payment category
Prosthetics & orthotics
Prior authorization
Not on Medicare required-PA list
Face-to-face & WOPD
Not on the required list
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.

Order readiness — what the written order must contain

Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):

  • Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
  • General description of the item (42 CFR 410.38(d)(1)(i)(B))
  • Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
  • Order date (42 CFR 410.38(d)(1)(i)(D))
  • Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
  • Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))

Not on the F2F/WOPD list (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

L6035 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $1473.92 to $1945.18 depending on state and rural status.

StateNon-ruralRural
AK$1859.66
AL$1482.21
AR$1613.46
AZ$1740.23
CA$1740.23
CO$1684.92
CT$1473.92
DC$1519.69
DE$1519.69
FL$1482.21
GA$1482.21
HI$1945.18
IA$1603.12
ID$1600.62
IL$1614.12
IN$1614.12
KS$1603.12
KY$1482.21
LA$1613.46
MA$1473.92
MD$1519.69
ME$1473.92
MI$1614.12
MN$1614.12
MO$1603.12
MS$1482.21
MT$1684.92
NC$1482.21
ND$1684.92
NE$1603.12
NH$1473.92
NJ$1502.65
NM$1613.46
NV$1740.23
NY$1502.65
OH$1614.12
OK$1613.46
OR$1600.62
PA$1519.69
PR$1844.85
RI$1473.92
SC$1482.21
SD$1684.92
TN$1482.21
TX$1613.46
UT$1684.92
VA$1519.69
VI$1565.25
VT$1473.92
WA$1600.62
WI$1614.12
WV$1519.69
WY$1684.92
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Common denial codes to watch

Related L-codes

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