L7405 HCPCS code: Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material
L7405 is the HCPCS Level II code for addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material. The 2026 Medicare DMEPOS fee schedule pays $873.65 to $961.06 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 5% from 2022 to 2024 (19 to 18 services). In 2024, 17 suppliers billed Medicare for L7405 (purchases), serving 16 beneficiaries. Its average fee ranks 6 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 L7405
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $873.65 | $961.06 | $1,066.15 | $799.61 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $873.65 | — |
| AL | — | $899.94 | — |
| AR | — | $899.88 | — |
| AZ | — | $873.65 | — |
| CA | — | $873.65 | — |
| CO | — | $904.89 | — |
| CT | — | $873.65 | — |
| DC | — | $873.65 | — |
| DE | — | $873.65 | — |
| FL | — | $899.94 | — |
| GA | — | $899.94 | — |
| HI | — | $873.65 | — |
| IA | — | $890.69 | — |
| ID | — | $873.65 | — |
| IL | — | $895.08 | — |
| IN | — | $895.08 | — |
| KS | — | $890.69 | — |
| KY | — | $899.94 | — |
| LA | — | $899.88 | — |
| MA | — | $873.65 | — |
| MD | — | $873.65 | — |
| ME | — | $873.65 | — |
| MI | — | $895.08 | — |
| MN | — | $895.08 | — |
| MO | — | $890.69 | — |
| MS | — | $899.94 | — |
| MT | — | $904.89 | — |
| NC | — | $899.94 | — |
| ND | — | $904.89 | — |
| NE | — | $890.69 | — |
| NH | — | $873.65 | — |
| NJ | — | $873.65 | — |
| NM | — | $899.88 | — |
| NV | — | $873.65 | — |
| NY | — | $873.65 | — |
| OH | — | $895.08 | — |
| OK | — | $899.88 | — |
| OR | — | $873.65 | — |
| PA | — | $873.65 | — |
| PR | — | $961.06 | — |
| RI | — | $873.65 | — |
| SC | — | $899.94 | — |
| SD | — | $904.89 | — |
| TN | — | $899.94 | — |
| TX | — | $899.88 | — |
| UT | — | $904.89 | — |
| VA | — | $873.65 | — |
| VI | — | $961.06 | — |
| VT | — | $873.65 | — |
| WA | — | $873.65 | — |
| WI | — | $895.08 | — |
| WV | — | $873.65 | — |
| WY | — | $904.89 | — |
How the L7405 fee compares
| Measure | Value |
|---|---|
| Rank among 7 L74 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $375.52–$3,150.07 |
| Rural fee uplift | — |
Who bills L7405 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 17 |
| Referring clinicians | 17 |
| Medicare beneficiaries | 16 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 16 | 18 |
| 2023 | 24 | 24 |
| 2024 | 17 | 16 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L7405, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 19 | 18 | $742.34 | $585.12 |
| 2023 | 25 | 24 | $828.71 | $649.71 |
| 2024 | 18 | 16 | $841.33 | $659.61 |
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 L7405
- 2026-01-01: Average state fee rose 2.0%: $873.18 to $890.64
- 2006-01-01: L7405 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 L7405?
L7405 is the HCPCS Level II code for addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material. Short descriptor: "Add ue prost s/d acrylic".
How much does Medicare pay for L7405?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $873.65–$961.06. Rural fees can be higher.
Does Medicare cover L7405?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L7405 change in 2026?
The average non-rural state fee moved from $873.18 in 2025 to $890.64 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L7405 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)
- L7404 — Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material ($668.02–$734.81)
- 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 L7405
- Watch L7405 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L7405
Sources: CMS HCPCS Level II release October 2026; 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.