13 commercial payer policies list L6955. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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13 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of L6955 |
|---|---|---|
| Cigna Commercial DME Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Upper Limb Prostheses | Jun 6, 2023 | Covered |
| Policy | Effective | Status of L6955 |
|---|
| Myoelectric Upper Extremity Prosthetic Devices | Jul 1, 2026 | Covered |
|---|
| Policy | Effective | Status of L6955 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Myoelectric Prosthetic and Orthotic Components for the Upper Limb | Jun 15, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Cigna Medicare Advantage Durable Medical Equipment Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Myoelectric and Microprocessor Prosthetic and Orthotic Components for the Upper Limb | Apr 1, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Upper Extremity Prosthetic Devices | Apr 1, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Upper Extremity Prosthetic Devices | Apr 1, 2026 | Covered |
| Policy | Effective | Status of L6955 |
|---|---|---|
| Upper Extremity Prosthetic Devices | Apr 1, 2026 | Covered |