# HCPCS Code L6590
## Definition
Healthcare Common Procedure Coding System (HCPCS) code L6590 is used to identify a specific type of prosthetic device or accessory. Code L6590 refers to “addition to upper extremity prosthesis, glove for terminal device, any material, custom fabricated.” This code applies to a custom-designed glove that fits over a prosthetic terminal device, serving both functional and cosmetic purposes for individuals with upper extremity amputations.
The glove included in the definition of code L6590 is distinguished by its custom fabrication, ensuring it meets the unique anatomical and functional needs of the patient. This code specifically pertains to gloves intended for upper extremity prosthetics, excluding standard off-the-shelf items. The material composition of the glove is not restricted, allowing for varied designs to accommodate patient-specific requirements such as durability, flexibility, and aesthetic appearance.
## Clinical Context
Custom-fabricated gloves such as those described by HCPCS code L6590 are essential components of an upper extremity prosthetic device for many patients. These gloves serve to protect the mechanical elements of a terminal device, such as hooks or hands, while also providing a natural appearance that improves the user’s self-esteem and social interactions. They are often selected when patients require a personalized fit or when mass-manufactured prosthetic gloves are insufficient.
The use of a prosthetic glove can assist in reducing wear and tear on the underlying terminal device, extending its functional lifespan. These gloves are frequently prescribed for individuals who rely on their prosthetics for daily living, including work-related and recreational activities. A prosthetist or clinician specializing in limb differences typically identifies the need for a glove as part of a comprehensive prosthetic treatment plan.
## Common Modifiers
Modifiers are frequently used with HCPCS code L6590 to provide additional detail about the services rendered or the circumstances under which the prosthetic glove was provided. For example, modifiers may indicate which side of the body the device is intended for, such as “right” or “left,” using the appropriate anatomical modifiers.
When a glove is provided as a replacement or repair rather than as part of the initial prosthetic device, relevant modifiers, such as repair or replacement indicators, are appended. Time-based modifiers may also apply in cases where service dates or usage information needs clarification for reimbursement purposes. The inclusion of accurate, descriptive modifiers is essential to avoid claim denials and ensure accurate payment.
## Documentation Requirements
Proper documentation for HCPCS code L6590 should clearly establish the medical necessity of the custom-fabricated prosthetic glove. The clinical record must include a comprehensive explanation of why an off-the-shelf glove is not suitable for the patient’s needs. Supporting evidence such as measurements, photographs, and detailed descriptions of the patient’s anatomy may also be required to justify the custom formulation.
Additionally, a physician’s prescription that explicitly requests a custom-fabricated glove must be included in the submission. The prescription should describe the intended functional benefits of the custom glove as well as the desired material and design specifications. Documentation must also outline the anticipated role of the glove in the patient’s prosthetic rehabilitation plan, emphasizing its contribution to improving quality of life or functionality.
## Common Denial Reasons
Claims for HCPCS code L6590 may be denied if supporting documentation is incomplete or fails to demonstrate the medical necessity for a custom-fabricated glove. One frequent reason for denial is the absence of a properly documented clinical rationale explaining why a standard product is inadequate. Insufficient or missing physician prescriptions also serve as a common basis for claim rejections.
Another common denial reason relates to the improper use or omission of modifiers, resulting in unclear or incomplete coding. Additionally, payers may reject claims if the coding submitted does not align with the patient’s specific diagnosis or clinical presentation. Ensuring proper documentation, coding accuracy, and alignment with payer policies is crucial to minimizing the potential for denials.
## Special Considerations for Commercial Insurers
When billing commercial insurance carriers for HCPCS code L6590, it is important to understand that policies regarding prosthetic accessory coverage can vary widely. Some insurers may impose stricter requirements than those applied by federal healthcare programs, necessitating thorough verification of the payer policy before submitting a claim. In some cases, prior authorization may be required to confirm coverage of a custom-fabricated prosthetic glove.
Commercial insurers may also place limitations on the frequency with which prosthetic gloves can be replaced, even when wear-and-tear or patient-specific needs dictate earlier replacement. It is advisable to review the policy’s guidelines for maintenance, repair, and replacement components to ensure timely and accurate reimbursement. Clinicians should also be prepared to appeal denials with detailed supporting documentation if coverage criteria are unexpectedly interpreted narrowly.
## Similar Codes
HCPCS code L6590 is specific to custom-fabricated prosthetic gloves, but there are several other codes in the HCPCS system that describe related prosthetic items. For example, code L6704 refers to non-customized (off-the-shelf) protective coverings for terminal devices, which may be considered when a patient does not require bespoke fabrication. Another related code, L6880, pertains to specialized prosthetic gloves designed for activities involving heavy-duty use, such as occupational tasks.
While L6590 focuses exclusively on upper extremity applications, other codes exist for lower extremity components, illustrating the variability across prosthetic coding. Comparing L6590 with similar or related codes can help clinicians determine the most appropriate billing code for unique patient scenarios. It is essential to select the code that most precisely reflects the item provided to facilitate accurate billing and reimbursement processes.