MyMedi-AI

L6692 — Upper extremity addition, silicone gel insert or equal, with or without locking mechanism, each

HCPCS Level II L-code · short descriptor: “Silicon gel insert w/wo lock”

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.

L6692 Medicare fee schedule (April 2026)

Base (no modifier) Prosthetics & orthotics

Medicare allowable ranges from $684.63 to $1142.13 depending on state and rural status.

Former-CBA payment limits: ceiling $912.85 · floor $684.63

StateNon-ruralRural
AK$997.18
AL$684.63
AR$871.10
AZ$912.85
CA$912.85
CO$856.60
CT$762.37
DC$684.63
DE$684.63
FL$684.63
GA$684.63
HI$1066.27
IA$692.77
ID$684.63
IL$787.53
IN$787.53
KS$692.77
KY$684.63
LA$871.10
MA$762.37
MD$684.63
ME$762.37
MI$787.53
MN$787.53
MO$692.77
MS$684.63
MT$856.60
NC$684.63
ND$856.60
NE$692.77
NH$762.37
NJ$694.42
NM$871.10
NV$912.85
NY$694.42
OH$787.53
OK$871.10
OR$684.63
PA$684.63
PR$1142.13
RI$762.37
SC$684.63
SD$856.60
TN$684.63
TX$871.10
UT$856.60
VA$684.63
VI$694.42
VT$762.37
WA$684.63
WI$787.53
WV$684.63
WY$856.60
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

Bill L6692 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 check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, L6692 included, and starter credits via POST /bot-marketplace/register.