L7403 HCPCS code: Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material
L7403 is the HCPCS Level II code for addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material. The 2026 Medicare DMEPOS fee schedule pays $442.58 to $486.81 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 7% from 2022 to 2024 (307 to 284 services). In 2024, 209 suppliers billed Medicare for L7403 (purchases), serving 242 beneficiaries; Texas, California, Florida accounted for 67% of services. Its average fee ranks 3 of 7 L74 codes (family range $375.52–$3,150.07).
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 | 2006-01-01 |
| Last action effective | 2006-01-01 |
2026 Medicare DMEPOS fee schedule for L7403
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $442.58 | $486.81 | $540.12 | $405.09 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $442.58 | — |
| AL | — | $455.94 | — |
| AR | — | $455.88 | — |
| AZ | — | $442.58 | — |
| CA | — | $442.58 | — |
| CO | — | $458.43 | — |
| CT | — | $442.58 | — |
| DC | — | $442.58 | — |
| DE | — | $442.58 | — |
| FL | — | $455.94 | — |
| GA | — | $455.94 | — |
| HI | — | $442.58 | — |
| IA | — | $451.24 | — |
| ID | — | $442.58 | — |
| IL | — | $453.48 | — |
| IN | — | $453.48 | — |
| KS | — | $451.24 | — |
| KY | — | $455.94 | — |
| LA | — | $455.88 | — |
| MA | — | $442.58 | — |
| MD | — | $442.58 | — |
| ME | — | $442.58 | — |
| MI | — | $453.48 | — |
| MN | — | $453.48 | — |
| MO | — | $451.24 | — |
| MS | — | $455.94 | — |
| MT | — | $458.43 | — |
| NC | — | $455.94 | — |
| ND | — | $458.43 | — |
| NE | — | $451.24 | — |
| NH | — | $442.58 | — |
| NJ | — | $442.58 | — |
| NM | — | $455.88 | — |
| NV | — | $442.58 | — |
| NY | — | $442.58 | — |
| OH | — | $453.48 | — |
| OK | — | $455.88 | — |
| OR | — | $442.58 | — |
| PA | — | $442.58 | — |
| PR | — | $486.81 | — |
| RI | — | $442.58 | — |
| SC | — | $455.94 | — |
| SD | — | $458.43 | — |
| TN | — | $455.94 | — |
| TX | — | $455.88 | — |
| UT | — | $458.43 | — |
| VA | — | $442.58 | — |
| VI | — | $486.81 | — |
| VT | — | $442.58 | — |
| WA | — | $442.58 | — |
| WI | — | $453.48 | — |
| WV | — | $442.58 | — |
| WY | — | $458.43 | — |
How the L7403 fee compares
| Measure | Value |
|---|---|
| Rank among 7 L74 codes (lowest = 1) | 3 |
| Family fee range (average of state fees) | $375.52–$3,150.07 |
| Rural fee uplift | — |
Who bills L7403 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 209 |
| Referring clinicians | 224 |
| Medicare beneficiaries | 242 |
| States with claims | 6 |
| Share of services in top 3 states (Texas, California, Florida) | 67% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 232 | 266 |
| 2023 | 273 | 334 |
| 2024 | 209 | 242 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L7403, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 307 | 266 | $385.01 | $299.55 |
| 2023 | 379 | 334 | $419.13 | $319.64 |
| 2024 | 284 | 242 | $430.22 | $331.69 |
States with the most L7403 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 31 | $342.25 |
| California | 29 | $331.61 |
| Florida | 21 | $342.86 |
| New York | 14 | $332.24 |
| Missouri | 14 | $339.82 |
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 L7403
- 2026-01-01: Average state fee rose 2.0%: $442.35 to $451.20
- 2006-01-01: L7403 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 L7403?
L7403 is the HCPCS Level II code for addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material. Short descriptor: "Add ue prost b/e acrylic".
How much does Medicare pay for L7403?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $442.58–$486.81. Rural fees can be higher.
Does Medicare cover L7403?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L7403 change in 2026?
The average non-rural state fee moved from $442.35 in 2025 to $451.20 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L7403 can be billed per day?
2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related L74 codes
- L7400 — Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal) ($368.35–$405.17)
- L7401 — Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal) ($412.39–$453.57)
- L7402 — Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal) ($445.33–$489.88)
- L7404 — Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material ($668.02–$734.81)
- L7405 — Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material ($873.65–$961.06)
- L7406 — Addition to upper extremity prosthesis, user adjustable, mechanical, residual limb volume management system (with or without lamination kit) ($3,150.07–$3,150.07)
- L7499 — Upper extremity prosthesis, not otherwise specified
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 L7403
- Watch L7403 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L7403
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.