L6677 — Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow
HCPCS Level II L-code · short descriptor: “Ue triple control harness”
- 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.
L6677 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $356.52 to $392.16 depending on state and rural status.
Former-CBA payment limits: ceiling $435.09 · floor $326.32
| State | Non-rural | Rural |
|---|---|---|
| AK | $356.52 | — |
| AL | $367.30 | — |
| AR | $367.25 | — |
| AZ | $356.52 | — |
| CA | $356.52 | — |
| CO | $369.29 | — |
| CT | $356.52 | — |
| DC | $356.52 | — |
| DE | $356.52 | — |
| FL | $367.30 | — |
| GA | $367.30 | — |
| HI | $356.52 | — |
| IA | $363.43 | — |
| ID | $356.52 | — |
| IL | $365.26 | — |
| IN | $365.26 | — |
| KS | $363.43 | — |
| KY | $367.30 | — |
| LA | $367.25 | — |
| MA | $356.52 | — |
| MD | $356.52 | — |
| ME | $356.52 | — |
| MI | $365.26 | — |
| MN | $365.26 | — |
| MO | $363.43 | — |
| MS | $367.30 | — |
| MT | $369.29 | — |
| NC | $367.30 | — |
| ND | $369.29 | — |
| NE | $363.43 | — |
| NH | $356.52 | — |
| NJ | $356.52 | — |
| NM | $367.25 | — |
| NV | $356.52 | — |
| NY | $356.52 | — |
| OH | $365.26 | — |
| OK | $367.25 | — |
| OR | $356.52 | — |
| PA | $356.52 | — |
| PR | $392.16 | — |
| RI | $356.52 | — |
| SC | $367.30 | — |
| SD | $369.29 | — |
| TN | $367.30 | — |
| TX | $367.25 | — |
| UT | $369.29 | — |
| VA | $356.52 | — |
| VI | $392.16 | — |
| VT | $356.52 | — |
| WA | $356.52 | — |
| WI | $365.26 | — |
| WV | $356.52 | — |
| WY | $369.29 | — |
Common denial codes to watch
Related L-codes
Bill L6677 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →
Building an AI agent? Try the agent API in the playground — free PA-required lookups, L6677 included, and starter credits via POST /bot-marketplace/register.