L6895 — Addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated
HCPCS Level II L-code · short descriptor: “Custom glove for term device”
- 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.
L6895 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $327.22 to $911.47 depending on state and rural status.
Former-CBA payment limits: ceiling $911.47 · floor $683.61
| State | Non-rural | Rural |
|---|---|---|
| AK | $651.37 | — |
| AL | $766.02 | — |
| AR | $683.61 | — |
| AZ | $683.61 | — |
| CA | $683.61 | — |
| CO | $698.69 | — |
| CT | $911.47 | — |
| DC | $757.88 | — |
| DE | $757.88 | — |
| FL | $766.02 | — |
| GA | $766.02 | — |
| HI | $696.49 | — |
| IA | $782.99 | — |
| ID | $759.01 | — |
| IL | $822.33 | — |
| IN | $822.33 | — |
| KS | $782.99 | — |
| KY | $766.02 | — |
| LA | $683.61 | — |
| MA | $911.47 | — |
| MD | $757.88 | — |
| ME | $911.47 | — |
| MI | $822.33 | — |
| MN | $822.33 | — |
| MO | $782.99 | — |
| MS | $766.02 | — |
| MT | $698.69 | — |
| NC | $766.02 | — |
| ND | $698.69 | — |
| NE | $782.99 | — |
| NH | $911.47 | — |
| NJ | $683.61 | — |
| NM | $683.61 | — |
| NV | $683.61 | — |
| NY | $683.61 | — |
| OH | $822.33 | — |
| OK | $683.61 | — |
| OR | $759.01 | — |
| PA | $757.88 | — |
| PR | $327.22 | — |
| RI | $911.47 | — |
| SC | $766.02 | — |
| SD | $698.69 | — |
| TN | $766.02 | — |
| TX | $683.61 | — |
| UT | $698.69 | — |
| VA | $757.88 | — |
| VI | $683.61 | — |
| VT | $911.47 | — |
| WA | $759.01 | — |
| WI | $822.33 | — |
| WV | $757.88 | — |
| WY | $698.69 | — |
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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