Procedure Code L6028 Update for Prosthetist and Orthotist Providers

Date: March 31, 2026

Attention: Prosthetist and Orthotist Providers

Call to action: Texas Children’s Health Plan would like to inform providers that effective March 26, 2026, procedure code L6028 is a payable benefit for prosthetist providers for dates of service on or after April 1, 2025.

When processing claims for procedure code L6028 on or after April 1, 2026, Texas Medicaid may have erroneously reimbursed the claims for orthotist providers and denied the claims for prosthetist providers. Texas Medicaid does not reimburse orthotist providers for procedure code L6028.

Texas Medicaid will reprocess any claims that are affected by this update. If there are any recoupments of claims reimbursements or additional reimbursement payments due, they will be reflected on future Remittance and Status (R&S) Reports.

Note: Procedure code L6028 is a payable benefit for prosthetist and durable medical equipment (DME) suppliers.

Next step for providers: Providers should share this communication with their staff.

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org. 

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.