L8000 HCPCS code: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
L8000 is the HCPCS Level II code for breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type. The 2026 Medicare DMEPOS fee schedule pays $44.70 to $78.16 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 6 per day on DME suppliers. Medicare volume fell 7% from 2022 to 2024 (342,765 to 318,080 services). In 2024, 1,480 suppliers billed Medicare for L8000 (purchases), serving 76,580 beneficiaries; Florida, Pennsylvania, California accounted for 21% of services. Its average fee ranks 2 of 17 L80 codes (family range $48.09–$5,112.29).
Code details
| Field | Value |
|---|---|
| Section | L codes — Orthotic and prosthetic procedures and devices |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1986-01-01 |
| Last action effective | 2013-01-01 |
2026 Medicare DMEPOS fee schedule for L8000
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $44.70 | $78.16 | $59.59 | $44.70 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $73.10 | — |
| AL | — | $53.85 | — |
| AR | — | $45.92 | — |
| AZ | — | $59.59 | — |
| CA | — | $59.59 | — |
| CO | — | $46.06 | — |
| CT | — | $45.52 | — |
| DC | — | $44.70 | — |
| DE | — | $44.70 | — |
| FL | — | $53.85 | — |
| GA | — | $53.85 | — |
| HI | — | $78.16 | — |
| IA | — | $49.52 | — |
| ID | — | $50.52 | — |
| IL | — | $52.13 | — |
| IN | — | $52.13 | — |
| KS | — | $49.52 | — |
| KY | — | $53.85 | — |
| LA | — | $45.92 | — |
| MA | — | $45.52 | — |
| MD | — | $44.70 | — |
| ME | — | $45.52 | — |
| MI | — | $52.13 | — |
| MN | — | $52.13 | — |
| MO | — | $49.52 | — |
| MS | — | $53.85 | — |
| MT | — | $46.06 | — |
| NC | — | $53.85 | — |
| ND | — | $46.06 | — |
| NE | — | $49.52 | — |
| NH | — | $45.52 | — |
| NJ | — | $45.10 | — |
| NM | — | $45.92 | — |
| NV | — | $59.59 | — |
| NY | — | $45.10 | — |
| OH | — | $52.13 | — |
| OK | — | $45.92 | — |
| OR | — | $50.52 | — |
| PA | — | $44.70 | — |
| PR | — | $57.10 | — |
| RI | — | $45.52 | — |
| SC | — | $53.85 | — |
| SD | — | $46.06 | — |
| TN | — | $53.85 | — |
| TX | — | $45.92 | — |
| UT | — | $46.06 | — |
| VA | — | $44.70 | — |
| VI | — | $45.09 | — |
| VT | — | $45.52 | — |
| WA | — | $50.52 | — |
| WI | — | $52.13 | — |
| WV | — | $44.70 | — |
| WY | — | $46.06 | — |
How the L8000 fee compares
| Measure | Value |
|---|---|
| Rank among 17 L80 codes (lowest = 1) | 2 |
| Family fee range (average of state fees) | $48.09–$5,112.29 |
| Rural fee uplift | — |
Who bills L8000 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,480 |
| Referring clinicians | 39,164 |
| Medicare beneficiaries | 76,580 |
| States with claims | 52 |
| Share of services in top 3 states (Florida, Pennsylvania, California) | 21% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,721 | 84,954 |
| 2023 | 1,555 | 82,456 |
| 2024 | 1,480 | 76,580 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8000, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 342,765 | 84,954 | $43.27 | $32.52 |
| 2023 | 340,676 | 82,456 | $46.89 | $35.22 |
| 2024 | 318,080 | 76,580 | $48.17 | $36.16 |
States with the most L8000 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 27,203 | $38.88 |
| Pennsylvania | 19,210 | $32.50 |
| California | 19,110 | $42.13 |
| Texas | 16,907 | $33.27 |
| Illinois | 14,885 | $37.19 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | Clinical: Data |
| outpatient hospital claims | 6 | Clinical: Data |
Medicare policy articles for this code
- A52478: External Breast Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (49 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C50.011 | Malignant neoplasm of nipple and areola, right female breast | 1 |
| C50.012 | Malignant neoplasm of nipple and areola, left female breast | 1 |
| C50.019 | Malignant neoplasm of nipple and areola, unspecified female breast | 1 |
| C50.111 | Malignant neoplasm of central portion of right female breast | 1 |
| C50.112 | Malignant neoplasm of central portion of left female breast | 1 |
| C50.119 | Malignant neoplasm of central portion of unspecified female breast | 1 |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast | 1 |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast | 1 |
| C50.219 | Malignant neoplasm of upper-inner quadrant of unspecified female breast | 1 |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast | 1 |
Showing 10 of 49. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for L8000
- 2026-01-01: Average state fee rose 2.0%: $49.26 to $50.24
- 1986-01-01: L8000 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code L8000?
L8000 is the HCPCS Level II code for breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type. Short descriptor: "Mastectomy bra".
How much does Medicare pay for L8000?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $44.70–$78.16. Rural fees can be higher.
Does Medicare cover L8000?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L8000?
Medicare policy articles that cite L8000 list 49 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C50.011 (Malignant neoplasm of nipple and areola, right female breast), C50.012 (Malignant neoplasm of nipple and areola, left female breast), C50.019 (Malignant neoplasm of nipple and areola, unspecified female breast). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for L8000 change in 2026?
The average non-rural state fee moved from $49.26 in 2025 to $50.24 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8000 can be billed per day?
6 on DME suppliers; 6 on outpatient hospital claims (NCCI medically unlikely edits).
Related L80 codes
- L8001 — Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type ($150.77–$165.83)
- L8002 — Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type ($198.27–$218.12)
- L8010 — Breast prosthesis, mastectomy sleeve
- L8015 — External breast prosthesis garment, with mastectomy form, post mastectomy ($72.05–$86.41)
- L8020 — Breast prosthesis, mastectomy form ($245.60–$366.25)
- L8030 — Breast prosthesis, silicone or equal, without integral adhesive ($386.23–$514.97)
- L8031 — Breast prosthesis, silicone or equal, with integral adhesive ($386.23–$514.97)
- L8032 — Nipple prosthesis, prefabricated, reusable, any type, each ($47.08–$51.79)
- L8033 — Nipple prosthesis, custom fabricated, reusable, any material, any type, each
- L8035 — Custom breast prosthesis, post mastectomy, molded to patient model ($4,403.11–$5,283.69)
- L8039 — Breast prosthesis, not otherwise specified
- L8040 — Nasal prosthesis, provided by a non-physician ($1,125.03–$3,577.33)
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under L8000
- Watch L8000 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8000
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.