MedicaidBilling CodesMedium impact
Procedure Code L6028 Update for Prosthetist and Orthotist Providers
Texas Medicaid·TX · PM&R (Physical Medicine & Rehab), Orthopedics·Coding
Effective date
Apr 1, 2025
We identified it
Mar 31, 2026
Summary
Texas Medicaid corrected billing rules for procedure code L6028, confirming it is payable for prosthetist providers but not orthotist providers, effective April 1, 2025. Claims were previously processed incorrectly, with orthotists being reimbursed and prosthetists being denied, but Texas Medicaid will automatically reprocess affected claims.
Action Required
Immediately: Verify that L6028 claims are only submitted by prosthetist and DME suppliers, not orthotist providers. Review any L6028 claims submitted on or after April 1, 2026 for correct provider type. Monitor future Remittance and Status (R&S) Reports for automatic reprocessing adjustments, recoupments, or additional payments. Contact TMHP at 800-925-9126 with questions.