L6034, Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at distal to metacarpal joint, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage (see 'Medical Records Documentation Used for Reviews').
- Physician order for the prosthetic device or order under the direction of a physician.
- Evaluation and documentation by a healthcare professional with appropriate prosthetic qualifications and training (prosthetist) under the supervision of the ordering physician.