L6628 — Upper extremity addition, quick disconnect hook adapter, otto bock or equal
L6628 is a HCPCS Level II code for upper extremity addition, quick disconnect hook adapter, otto bock or equal. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of L6628 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- DME supplier
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for L6628
- Long descriptor
- Upper extremity addition, quick disconnect hook adapter, otto bock or equal
- Short descriptor
- Quick disconn hook adapter o
- Added
- January 1, 1988
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to L6628
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L6628 is not quite right, the correct code is very often within a few positions of it.
- L6611Addition to upper extremity prosthesis, external powered, additional switch, any type
- L6615Upper extremity addition, disconnect locking wrist unit
- L6616Upper extremity addition, additional disconnect insert for locking wrist unit, each
- L6620Upper extremity addition, flexion/extension wrist unit, with or without friction
- L6621Upper extremity prosthesis addition, flexion/extension wrist with or without friction, for use with external powered terminal device
- L6623Upper extremity addition, spring assisted rotational wrist unit with latch release
- L6624Upper extremity addition, flexion/extension and rotation wrist unit
- L6625Upper extremity addition, rotation wrist unit with cable lock
- L6629Upper extremity addition, quick disconnect lamination collar with coupling piece, otto bock or equal
- L6630Upper extremity addition, stainless steel, any wrist
- L6632Upper extremity addition, latex suspension sleeve, each
- L6635Upper extremity addition, lift assist for elbow
- L6637Upper extremity addition, nudge control elbow lock
- L6638Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow
- L6640Upper extremity additions, shoulder abduction joint, pair
- L6641Upper extremity addition, excursion amplifier, pulley type
Questions about L6628
What is HCPCS code L6628?
L6628 is a HCPCS Level II code for upper extremity addition, quick disconnect hook adapter, otto bock or equal. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L6628?
The CMS HCPCS file marks L6628 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.