L6697 — Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
HCPCS Level II L-code · short descriptor: “Cus elbo skt in not con/atyp”
- 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.
L6697 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $1580.90 to $1738.98 depending on state and rural status.
Former-CBA payment limits: ceiling $1929.74 · floor $1447.31
| State | Non-rural | Rural |
|---|---|---|
| AK | $1580.90 | — |
| AL | $1628.51 | — |
| AR | $1628.34 | — |
| AZ | $1580.90 | — |
| CA | $1580.90 | — |
| CO | $1640.77 | — |
| CT | $1580.90 | — |
| DC | $1580.90 | — |
| DE | $1580.90 | — |
| FL | $1628.51 | — |
| GA | $1628.51 | — |
| HI | $1580.90 | — |
| IA | $1611.74 | — |
| ID | $1580.90 | — |
| IL | $1619.74 | — |
| IN | $1619.74 | — |
| KS | $1611.74 | — |
| KY | $1628.51 | — |
| LA | $1628.34 | — |
| MA | $1580.90 | — |
| MD | $1580.90 | — |
| ME | $1580.90 | — |
| MI | $1619.74 | — |
| MN | $1619.74 | — |
| MO | $1611.74 | — |
| MS | $1628.51 | — |
| MT | $1640.77 | — |
| NC | $1628.51 | — |
| ND | $1640.77 | — |
| NE | $1611.74 | — |
| NH | $1580.90 | — |
| NJ | $1580.90 | — |
| NM | $1628.34 | — |
| NV | $1580.90 | — |
| NY | $1580.90 | — |
| OH | $1619.74 | — |
| OK | $1628.34 | — |
| OR | $1580.90 | — |
| PA | $1580.90 | — |
| PR | $1738.98 | — |
| RI | $1580.90 | — |
| SC | $1628.51 | — |
| SD | $1640.77 | — |
| TN | $1628.51 | — |
| TX | $1628.34 | — |
| UT | $1640.77 | — |
| VA | $1580.90 | — |
| VI | $1738.98 | — |
| VT | $1580.90 | — |
| WA | $1580.90 | — |
| WI | $1619.74 | — |
| WV | $1580.90 | — |
| WY | $1640.77 | — |
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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