L6695 — Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric or equal, not for use with locking mechanism
HCPCS Level II L-code · short descriptor: “Elbow socket ins use w/o lck”
- 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
- 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.
L6695 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $633.27 to $997.21 depending on state and rural status.
Former-CBA payment limits: ceiling $908.93 · floor $681.70
| State | Non-rural | Rural |
|---|---|---|
| AK | $854.21 | — |
| AL | $725.39 | — |
| AR | $747.37 | — |
| AZ | $799.39 | — |
| CA | $799.39 | — |
| CO | $772.95 | — |
| CT | $804.82 | — |
| DC | $716.74 | — |
| DE | $716.74 | — |
| FL | $725.39 | — |
| GA | $725.39 | — |
| HI | $997.21 | — |
| IA | $764.25 | — |
| ID | $730.77 | — |
| IL | $806.49 | — |
| IN | $806.49 | — |
| KS | $764.25 | — |
| KY | $725.39 | — |
| LA | $747.37 | — |
| MA | $804.82 | — |
| MD | $716.74 | — |
| ME | $804.82 | — |
| MI | $806.49 | — |
| MN | $806.49 | — |
| MO | $764.25 | — |
| MS | $725.39 | — |
| MT | $772.95 | — |
| NC | $725.39 | — |
| ND | $772.95 | — |
| NE | $764.25 | — |
| NH | $804.82 | — |
| NJ | $681.70 | — |
| NM | $747.37 | — |
| NV | $799.39 | — |
| NY | $681.70 | — |
| OH | $806.49 | — |
| OK | $747.37 | — |
| OR | $730.77 | — |
| PA | $716.74 | — |
| PR | $633.27 | — |
| RI | $804.82 | — |
| SC | $725.39 | — |
| SD | $772.95 | — |
| TN | $725.39 | — |
| TX | $747.37 | — |
| UT | $772.95 | — |
| VA | $716.74 | — |
| VI | $681.70 | — |
| VT | $804.82 | — |
| WA | $730.77 | — |
| WI | $806.49 | — |
| WV | $716.74 | — |
| WY | $772.95 | — |
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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