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L6205 — Elbow disarticulation, molded socket with expandable interface, outside locking hinges, forearm

HCPCS Level II L-code · short descriptor: “Elbow molded w/ expand inter”

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.

L6205 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $4458.17 to $6051.96 depending on state and rural status.

Former-CBA payment limits: ceiling $5944.23 · floor $4458.17

StateNon-ruralRural
AK$5659.69
AL$4458.17
AR$4458.17
AZ$5435.97
CA$5435.97
CO$4572.10
CT$5640.91
DC$5565.49
DE$5565.49
FL$4458.17
GA$4458.17
HI$6051.96
IA$4579.66
ID$5433.19
IL$5556.38
IN$5556.38
KS$4579.66
KY$4458.17
LA$4458.17
MA$5640.91
MD$5565.49
ME$5640.91
MI$5556.38
MN$5556.38
MO$4579.66
MS$4458.17
MT$4572.10
NC$4458.17
ND$4572.10
NE$4579.66
NH$5640.91
NJ$5012.28
NM$4458.17
NV$5435.97
NY$5012.28
OH$5556.38
OK$4458.17
OR$5433.19
PA$5565.49
PR$4663.64
RI$5640.91
SC$4458.17
SD$4572.10
TN$4458.17
TX$4458.17
UT$4572.10
VA$5565.49
VI$5012.28
VT$5640.91
WA$5433.19
WI$5556.38
WV$5565.49
WY$4572.10
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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