L8701 – Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated

HCPCS Level II code · L codes: Orthotic and Prosthetic Procedures and Devices

Active code Carrier judgment

HCPCS codeL8701
Long description
Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
Short description
Ewh s/d uprt micro sensor
Pricing indicator
38 Orthotics, prosthetics, prosthetic devices & vision services
Medicare coverage
C Carrier judgment – coverage decided by the Medicare contractor
BETOS category
D1F Prosthetic/Orthotic devices
Added
January 1, 2019
Last change
January 1, 2024 – No change

Frequently asked questions

What is HCPCS code L8701?

L8701 is a HCPCS Level II code for powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated.

Does Medicare cover L8701?

The HCPCS file lists coverage code C: Carrier judgment – coverage decided by the Medicare contractor. Coverage and payment also depend on local coverage determinations and the patient’s plan.

Nearby L codes

Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.