L7404 HCPCS code: Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
L7404 is the HCPCS Level II code for addition to upper extremity prosthesis, above elbow disarticulation, acrylic material. The 2026 Medicare DMEPOS fee schedule pays $668.02 to $734.81 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. In 2024, 91 suppliers billed Medicare for L7404 (purchases), serving 94 beneficiaries. Its average fee ranks 5 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 L7404
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $668.02 | $734.81 | $815.20 | $611.40 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $668.02 | — |
| AL | — | $688.07 | — |
| AR | — | $688.03 | — |
| AZ | — | $668.02 | — |
| CA | — | $668.02 | — |
| CO | — | $691.93 | — |
| CT | — | $668.02 | — |
| DC | — | $668.02 | — |
| DE | — | $668.02 | — |
| FL | — | $688.07 | — |
| GA | — | $688.07 | — |
| HI | — | $668.02 | — |
| IA | — | $681.03 | — |
| ID | — | $668.02 | — |
| IL | — | $684.45 | — |
| IN | — | $684.45 | — |
| KS | — | $681.03 | — |
| KY | — | $688.07 | — |
| LA | — | $688.03 | — |
| MA | — | $668.02 | — |
| MD | — | $668.02 | — |
| ME | — | $668.02 | — |
| MI | — | $684.45 | — |
| MN | — | $684.45 | — |
| MO | — | $681.03 | — |
| MS | — | $688.07 | — |
| MT | — | $691.93 | — |
| NC | — | $688.07 | — |
| ND | — | $691.93 | — |
| NE | — | $681.03 | — |
| NH | — | $668.02 | — |
| NJ | — | $668.02 | — |
| NM | — | $688.03 | — |
| NV | — | $668.02 | — |
| NY | — | $668.02 | — |
| OH | — | $684.45 | — |
| OK | — | $688.03 | — |
| OR | — | $668.02 | — |
| PA | — | $668.02 | — |
| PR | — | $734.81 | — |
| RI | — | $668.02 | — |
| SC | — | $688.07 | — |
| SD | — | $691.93 | — |
| TN | — | $688.07 | — |
| TX | — | $688.03 | — |
| UT | — | $691.93 | — |
| VA | — | $668.02 | — |
| VI | — | $734.81 | — |
| VT | — | $668.02 | — |
| WA | — | $668.02 | — |
| WI | — | $684.45 | — |
| WV | — | $668.02 | — |
| WY | — | $691.93 | — |
How the L7404 fee compares
| Measure | Value |
|---|---|
| Rank among 7 L74 codes (lowest = 1) | 5 |
| Family fee range (average of state fees) | $375.52–$3,150.07 |
| Rural fee uplift | — |
Who bills L7404 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 91 |
| Referring clinicians | 96 |
| Medicare beneficiaries | 94 |
| States with claims | 2 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 88 | 96 |
| 2023 | 82 | 95 |
| 2024 | 91 | 94 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L7404, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 104 | 96 | $580.07 | $454.23 |
| 2023 | 103 | 95 | $635.17 | $493.46 |
| 2024 | 104 | 94 | $650.89 | $505.48 |
States with the most L7404 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 14 | $465.61 |
| Texas | 14 | $516.44 |
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 L7404
- 2026-01-01: Average state fee rose 2.0%: $667.65 to $681.00
- 2006-01-01: L7404 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 L7404?
L7404 is the HCPCS Level II code for addition to upper extremity prosthesis, above elbow disarticulation, acrylic material. Short descriptor: "Add ue prost a/e acrylic".
How much does Medicare pay for L7404?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $668.02–$734.81. Rural fees can be higher.
Does Medicare cover L7404?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L7404 change in 2026?
The average non-rural state fee moved from $667.65 in 2025 to $681.00 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L7404 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)
- L7403 — Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material ($442.58–$486.81)
- 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 L7404
- Watch L7404 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L7404
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.