Does L6700 require prior authorization?

Yes, L6700 requires prior authorization (high confidence). Code explicitly requires prior authorization.

`L6700`, Upper extremity addition, external powered feature, myoelectronic control

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Clinical documentation establishing that the equipment is necessary and reasonable and is expected to make a meaningful contribution to treatment or functional improvement.
Documentation that education regarding use of the device was provided and the member/caregiver demonstrated understanding.
Documentation of a trial of the requested device with evidence the member can use it safely and effectively.
Documentation that the patient has newly diagnosed nonischemic cardiomyopathy and is undergoing a trial of optimal medical therapy.

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

AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines

DME104.001, Myoelectric Prosthetic and Orthotic Components for the Upper Limb

BCBSIL-DME104.001, Myoelectric Prosthetic and Orthotic Components for the Upper Limb

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