L7499 — Upper extremity prosthesis, not otherwise specified
L7499 is a HCPCS Level II code for upper extremity prosthesis, not otherwise specified. 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 L7499 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 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
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 L7499
- Long descriptor
- Upper extremity prosthesis, not otherwise specified
- Short descriptor
- Upper extremity prosthes nos
- Added
- January 1, 1985
- BETOS
- D1F
- Pricing indicator
- 46 — 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.
Carrier priced — not otherwise classified, individual determination, carrier discretion, or gap-filled amounts.
Codes adjacent to L7499
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L7499 is not quite right, the correct code is very often within a few positions of it.
- L7368Lithium ion battery charger, replacement only
- L7400Addition to upper extremity prosthesis, below elbow/wrist disarticulation, ultralight material (titanium, carbon fiber or equal)
- L7401Addition to upper extremity prosthesis, above elbow disarticulation, ultralight material (titanium, carbon fiber or equal)
- L7402Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, ultralight material (titanium, carbon fiber or equal)
- L7403Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material
- L7404Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material
- L7405Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material
- L7406Addition to upper extremity prosthesis, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)
- L7510Repair of prosthetic device, repair or replace minor parts
- L7520Repair prosthetic device, labor component, per 15 minutes
- L7600Prosthetic donning sleeve, any material, each
- L7700Gasket or seal, for use with prosthetic socket insert, any type, each
- L7900Male vacuum erection system
- L7902Tension ring, for vacuum erection device, any type, replacement only, each
- L8000Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
- L8001Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
Questions about L7499
What is HCPCS code L7499?
L7499 is a HCPCS Level II code for upper extremity prosthesis, not otherwise specified. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L7499?
The CMS HCPCS file marks L7499 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.