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Independence Blue CrossCommercial · Billing Codes · Medical Policy · Physical Therapy, Occupational Therapy, Orthopedics +2 moreMedium impact

05.00.72j, Upper Limb Prostheses

Effective date
Oct 28, 2026
Identified
Oct 29, 2026

Summary

Independence Blue Cross reissued Medical Policy 05.00.72j for Upper Limb Prostheses effective 10/28/2026, reflecting the company's continuing position on coverage criteria. HCPCS code L7499 (upper extremity prosthetic devices, not otherwise specified) was added, three partial hand codes (L6000, L6010, L6020) were deleted, and code L6028 was revised in the policy attachment. The coverage criteria for passive, body-powered, and myoelectric prostheses remain unchanged from prior versions.

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What to do

Action · 3 steps
01Previously due 2026-10-28 (date passed; verify current applicability) (already effective): Billing team must update claim submission and billing software to reflect HCPCS code changes in Attachment A of Policy 05.00.72j: add L7499 for upper extremity prosthetic devices NOS, delete L6000, L6010, and L6020 (partial hand codes), and implement the revised L6028 descriptor.
02Verify that any claims submitted after 10/28/2026 for upper limb prostheses use the updated code set and reflect the current coverage criteria (passive/body-powered devices require comprehensive evaluation and prosthetist fitting; myoelectric devices require additional functional capacity and trial period documentation).
03Confirm applicability to the practice's current payer agreements, as Independence Blue Cross policies apply per individual benefit verification.

Codes mentioned

L7499L6000L6010L6020L6028

Original notice

05.00.72j, Upper Limb Prostheses
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA05.057f, Upper-Limb ProsthesesMediumEffective Apr 1, 2026 · Medical PolicyMA05.057f, Upper-Limb ProsthesesMediumEffective Apr 1, 2026 · Medical Policy05.00.72j, Upper Limb ProsthesesMediumEffective Apr 1, 2026 · Medical PolicyMA00.010aw, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesHighEffective Apr 1, 2026 · NetworkBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPhysical TherapyOccupational TherapyOrthopedicsPlastic SurgeryGeneral SurgeryCode L7499Code L6000Code L6010Code L6020Code L6028

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