L6370 HCPCS code: Interscapular thoracic, passive restoration (shoulder cap only)
L6370 is the HCPCS Level II code for interscapular thoracic, passive restoration (shoulder cap only). The 2026 Medicare DMEPOS fee schedule pays $1,145.38 to $3,911.96 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on DME suppliers. Its average fee ranks 7 of 11 L63 codes (family range $573.91–$5,405.67).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1986-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L6370
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,145.38 | $3,911.96 | $3,315.39 | $2,486.54 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $3,658.43 | — |
| AL | — | $2,580.53 | — |
| AR | — | $2,718.61 | — |
| AZ | — | $3,315.39 | — |
| CA | — | $3,315.39 | — |
| CO | — | $2,486.54 | — |
| CT | — | $2,564.96 | — |
| DC | — | $2,963.68 | — |
| DE | — | $2,963.68 | — |
| FL | — | $2,580.53 | — |
| GA | — | $2,580.53 | — |
| HI | — | $3,911.96 | — |
| IA | — | $2,759.46 | — |
| ID | — | $2,486.54 | — |
| IL | — | $3,015.22 | — |
| IN | — | $3,015.22 | — |
| KS | — | $2,759.46 | — |
| KY | — | $2,580.53 | — |
| LA | — | $2,718.61 | — |
| MA | — | $2,564.96 | — |
| MD | — | $2,963.68 | — |
| ME | — | $2,564.96 | — |
| MI | — | $3,015.22 | — |
| MN | — | $3,015.22 | — |
| MO | — | $2,759.46 | — |
| MS | — | $2,580.53 | — |
| MT | — | $2,486.54 | — |
| NC | — | $2,580.53 | — |
| ND | — | $2,486.54 | — |
| NE | — | $2,759.46 | — |
| NH | — | $2,564.96 | — |
| NJ | — | $3,315.39 | — |
| NM | — | $2,718.61 | — |
| NV | — | $3,315.39 | — |
| NY | — | $3,315.39 | — |
| OH | — | $3,015.22 | — |
| OK | — | $2,718.61 | — |
| OR | — | $2,486.54 | — |
| PA | — | $2,963.68 | — |
| PR | — | $1,145.38 | — |
| RI | — | $2,564.96 | — |
| SC | — | $2,580.53 | — |
| SD | — | $2,486.54 | — |
| TN | — | $2,580.53 | — |
| TX | — | $2,718.61 | — |
| UT | — | $2,486.54 | — |
| VA | — | $2,963.68 | — |
| VI | — | $3,315.39 | — |
| VT | — | $2,564.96 | — |
| WA | — | $2,486.54 | — |
| WI | — | $3,015.22 | — |
| WV | — | $2,963.68 | — |
| WY | — | $2,486.54 | — |
How the L6370 fee compares
| Measure | Value |
|---|---|
| Rank among 11 L63 codes (lowest = 1) | 7 |
| Family fee range (average of state fees) | $573.91–$5,405.67 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for L6370
- 2026-01-01: Average state fee rose 2.0%: $2,728.92 to $2,783.50
- 1986-01-01: L6370 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L6370?
L6370 is the HCPCS Level II code for interscapular thoracic, passive restoration (shoulder cap only). Short descriptor: "Thoracic passive restor cap".
How much does Medicare pay for L6370?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,145.38–$3,911.96. Rural fees can be higher.
Does Medicare cover L6370?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L6370 change in 2026?
The average non-rural state fee moved from $2,728.92 in 2025 to $2,783.50 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L6370 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L63 codes
- L6300 — Shoulder disarticulation, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm ($2,658.47–$6,899.63)
- L6310 — Shoulder disarticulation, passive restoration (complete prosthesis) ($1,411.10–$5,563.52)
- L6320 — Shoulder disarticulation, passive restoration (shoulder cap only) ($1,002.06–$3,569.77)
- L6350 — Interscapular thoracic, molded socket, shoulder bulkhead, humeral section, internal locking elbow, forearm ($3,169.88–$6,936.42)
- L6360 — Interscapular thoracic, passive restoration (complete prosthesis) ($1,533.73–$7,462.35)
- L6380 — Immediate post surgical or early fitting, application of initial rigid dressing, including fitting alignment and suspension of components, and one cast change, wrist disarticulation or below elbow ($1,425.59–$2,093.90)
- L6382 — Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, elbow disarticulation or above elbow ($1,841.69–$3,426.39)
- L6384 — Immediate post surgical or early fitting, application of initial rigid dressing including fitting alignment and suspension of components, and one cast change, shoulder disarticulation or interscapular thoracic ($2,334.16–$3,997.43)
- L6386 — Immediate post surgical or early fitting, each additional cast change and realignment ($491.64–$1,427.66)
- L6388 — Immediate post surgical or early fitting, application of rigid dressing only ($464.61–$717.61)
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Next steps
- Run a reimbursement report for a device billed under L6370
- Watch L6370 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L6370
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.