Does L6677 require prior authorization?

No, L6677 does not require prior authorization (high confidence). Code is covered without prior authorization.

`L6677`, Upper extremity addition, harness, triple control, simultaneous operation of

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Upper extremity prosthetic device is medically necessary when: (a) traumatic or surgical amputation or congenital absence; (b) prosthetic replaces all/part of missing limb; (c) prosthetic will help regain/maintain function; (d) device ordered by/under direction of physician; (e) needs evaluated by qualified professional annually; (f) patient willing/able to train; (g) rehabilitation potential with ADL/IADL assessment.
Myoelectric upper extremity prosthetic devices are consideredmedically necessarywhen ALL of the criteria below have been met:
The individual has an amputation or absence of a portion of an arm;and
Clinical records, including assessment by a trained prosthetic clinician, support that the individual has sufficient ability to operate the myoelectric technology effectively;and
A body-powered prosthetic device cannot be used or is insufficient to meet the functional goals and needs of the individual;and
A myoelectric device is likely to help the individual regain or maintain function better than a standard body-powered prosthetic device;and

ANTHEM-GL-C169421, CG-OR-PR-05 Myoelectric Upper Extremity Prosthetic Devices

UHC-POL-upper-extremity-prosthetic-devices, Upper Extremity Prosthetic Devices

UMR-POL-UMR-upper-extremity-prosthetic-devices, Upper Extremity Prosthetic Devices

SUREST-POL-SUREST-upper-extremity-prosthetic-devices, Upper Extremity Prosthetic Devices

Ask Verity about documentation requirements, denial risks, or coverage in your state.