L6697 HCPCS code: Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
L6697 is the HCPCS Level II code for addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695). The 2026 Medicare DMEPOS fee schedule pays $1,580.90 to $1,738.98 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. Medicare volume fell 22% from 2022 to 2024 (36 to 28 services). In 2024, 19 suppliers billed Medicare for L6697 (purchases), serving 22 beneficiaries. Its average fee ranks 43 of 50 L66 codes (family range $61.02–$4,614.32).
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 | 2005-01-01 |
| Last action effective | 2005-01-01 |
2026 Medicare DMEPOS fee schedule for L6697
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1,580.90 | $1,738.98 | $1,929.74 | $1,447.31 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1,580.90 | — |
| AL | — | $1,628.51 | — |
| AR | — | $1,628.34 | — |
| AZ | — | $1,580.90 | — |
| CA | — | $1,580.90 | — |
| CO | — | $1,640.77 | — |
| CT | — | $1,580.90 | — |
| DC | — | $1,580.90 | — |
| DE | — | $1,580.90 | — |
| FL | — | $1,628.51 | — |
| GA | — | $1,628.51 | — |
| HI | — | $1,580.90 | — |
| IA | — | $1,611.74 | — |
| ID | — | $1,580.90 | — |
| IL | — | $1,619.74 | — |
| IN | — | $1,619.74 | — |
| KS | — | $1,611.74 | — |
| KY | — | $1,628.51 | — |
| LA | — | $1,628.34 | — |
| MA | — | $1,580.90 | — |
| MD | — | $1,580.90 | — |
| ME | — | $1,580.90 | — |
| MI | — | $1,619.74 | — |
| MN | — | $1,619.74 | — |
| MO | — | $1,611.74 | — |
| MS | — | $1,628.51 | — |
| MT | — | $1,640.77 | — |
| NC | — | $1,628.51 | — |
| ND | — | $1,640.77 | — |
| NE | — | $1,611.74 | — |
| NH | — | $1,580.90 | — |
| NJ | — | $1,580.90 | — |
| NM | — | $1,628.34 | — |
| NV | — | $1,580.90 | — |
| NY | — | $1,580.90 | — |
| OH | — | $1,619.74 | — |
| OK | — | $1,628.34 | — |
| OR | — | $1,580.90 | — |
| PA | — | $1,580.90 | — |
| PR | — | $1,738.98 | — |
| RI | — | $1,580.90 | — |
| SC | — | $1,628.51 | — |
| SD | — | $1,640.77 | — |
| TN | — | $1,628.51 | — |
| TX | — | $1,628.34 | — |
| UT | — | $1,640.77 | — |
| VA | — | $1,580.90 | — |
| VI | — | $1,738.98 | — |
| VT | — | $1,580.90 | — |
| WA | — | $1,580.90 | — |
| WI | — | $1,619.74 | — |
| WV | — | $1,580.90 | — |
| WY | — | $1,640.77 | — |
How the L6697 fee compares
| Measure | Value |
|---|---|
| Rank among 50 L66 codes (lowest = 1) | 43 |
| Family fee range (average of state fees) | $61.02–$4,614.32 |
| Rural fee uplift | — |
Who bills L6697 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 19 |
| Referring clinicians | 21 |
| Medicare beneficiaries | 22 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 29 | 31 |
| 2023 | 35 | 40 |
| 2024 | 19 | 22 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L6697, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 36 | 31 | $1,382.85 | $1,086.34 |
| 2023 | 42 | 40 | $1,503.97 | $1,146.68 |
| 2024 | 28 | 22 | $1,538.47 | $1,206.16 |
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 L6697
- 2026-01-01: Average state fee rose 2.0%: $1,580.42 to $1,612.03
- 2005-01-01: L6697 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 L6697?
L6697 is the HCPCS Level II code for addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695). Short descriptor: "Cus elbo skt in not con/atyp".
How much does Medicare pay for L6697?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1,580.90–$1,738.98. Rural fees can be higher.
Does Medicare cover L6697?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L6697 change in 2026?
The average non-rural state fee moved from $1,580.42 in 2025 to $1,612.03 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L6697 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L66 codes
- L6600 — Upper extremity additions, polycentric hinge, pair ($153.44–$409.35)
- L6605 — Upper extremity additions, single pivot hinge, pair ($133.09–$425.09)
- L6610 — Upper extremity additions, flexible metal hinge, pair ($122.80–$355.20)
- L6611 — Addition to upper extremity prosthesis, external powered, additional switch, any type ($494.85–$544.35)
- L6615 — Upper extremity addition, disconnect locking wrist unit ($122.80–$263.80)
- L6616 — Upper extremity addition, additional disconnect insert for locking wrist unit, each ($76.10–$105.88)
- L6620 — Upper extremity addition, flexion/extension wrist unit, with or without friction ($265.71–$513.87)
- L6621 — Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device ($2,748.98–$3,023.86)
- L6623 — Upper extremity addition, spring assisted rotational wrist unit with latch release ($142.76–$1,047.08)
- L6624 — Upper extremity addition, flexion/extension and rotation wrist unit ($4,526.27–$4,978.89)
- L6625 — Upper extremity addition, rotation wrist unit with cable lock ($286.30–$1,187.86)
- L6628 — Upper extremity addition, quick disconnect hook adapter, otto bock or equal ($66.65–$781.97)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L6697
- Watch L6697 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L6697
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.