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L6250 — Above elbow, molded double wall socket, internal locking elbow, forearm

HCPCS Level II L-code · short descriptor: “Elbow inter loc elbow forarm”

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.

L6250 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $2044.98 to $5285.01 depending on state and rural status.

Former-CBA payment limits: ceiling $4383.37 · floor $3287.52

StateNon-ruralRural
AK$4942.48
AL$3499.39
AR$4044.42
AZ$4383.37
CA$4383.37
CO$3323.72
CT$3372.73
DC$3287.52
DE$3287.52
FL$3499.39
GA$3499.39
HI$5285.01
IA$3873.69
ID$4044.22
IL$3962.73
IN$3962.73
KS$3873.69
KY$3499.39
LA$4044.42
MA$3372.73
MD$3287.52
ME$3372.73
MI$3962.73
MN$3962.73
MO$3873.69
MS$3499.39
MT$3323.72
NC$3499.39
ND$3323.72
NE$3873.69
NH$3372.73
NJ$3464.57
NM$4044.42
NV$4383.37
NY$3464.57
OH$3962.73
OK$4044.42
OR$4044.22
PA$3287.52
PR$2044.98
RI$3372.73
SC$3499.39
SD$3323.72
TN$3499.39
TX$4044.42
UT$3323.72
VA$3287.52
VI$3464.57
VT$3372.73
WA$4044.22
WI$3962.73
WV$3287.52
WY$3323.72
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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