L7499 HCPCS code: Upper extremity prosthesis, not otherwise specified
L7499 is the HCPCS Level II code for upper extremity prosthesis, not otherwise specified. In 2024 Medicare paid an average of $3,519.16 per service for L7499 across 113 services. 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 outpatient hospital claims. Medicare volume fell 18% from 2022 to 2024 (138 to 113 services). In 2024, 74 suppliers billed Medicare for L7499 (purchases), serving 81 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 46 — Priced by the Medicare contractor (no national fee) |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1985-01-01 |
| Last action effective | 1998-01-01 |
Who bills L7499 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 74 |
| Referring clinicians | 79 |
| Medicare beneficiaries | 81 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 66 | 76 |
| 2023 | 71 | 77 |
| 2024 | 74 | 81 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L7499, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 138 | 76 | $2,675.53 | $2,102.95 |
| 2023 | 116 | 77 | $5,163.70 | $4,044.72 |
| 2024 | 113 | 81 | $4,722.76 | $3,519.16 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Clinical: CMS Workgroup |
What changed for L7499
- 1985-01-01: L7499 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 L7499?
L7499 is the HCPCS Level II code for upper extremity prosthesis, not otherwise specified. Short descriptor: "Upper extremity prosthes nos".
How much does Medicare pay for L7499?
In 2024, the average Medicare payment was $3,519.16 per service (average allowed $4,722.76).
Does Medicare cover L7499?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of L7499 can be billed per day?
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)
- 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)
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 L7499
- Watch L7499 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L7499
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; 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.