L8020 HCPCS code: Breast prosthesis, mastectomy form
L8020 is the HCPCS Level II code for breast prosthesis, mastectomy form. The 2026 Medicare DMEPOS fee schedule pays $245.60 to $366.25 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 4 per day on DME suppliers. Medicare volume fell 3% from 2022 to 2024 (18,533 to 17,954 services). In 2024, 668 suppliers billed Medicare for L8020 (purchases), serving 11,427 beneficiaries; Florida, North Carolina, Texas accounted for 35% of services. Its average fee ranks 6 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 | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L8020
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $245.60 | $366.25 | $327.46 | $245.60 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $251.18 | — |
| AL | — | $279.11 | — |
| AR | — | $278.14 | — |
| AZ | — | $255.91 | — |
| CA | — | $255.91 | — |
| CO | — | $245.60 | — |
| CT | — | $245.60 | — |
| DC | — | $306.30 | — |
| DE | — | $306.30 | — |
| FL | — | $279.11 | — |
| GA | — | $279.11 | — |
| HI | — | $268.60 | — |
| IA | — | $291.65 | — |
| ID | — | $294.95 | — |
| IL | — | $278.40 | — |
| IN | — | $278.40 | — |
| KS | — | $291.65 | — |
| KY | — | $279.11 | — |
| LA | — | $278.14 | — |
| MA | — | $245.60 | — |
| MD | — | $306.30 | — |
| ME | — | $245.60 | — |
| MI | — | $278.40 | — |
| MN | — | $278.40 | — |
| MO | — | $291.65 | — |
| MS | — | $279.11 | — |
| MT | — | $245.60 | — |
| NC | — | $279.11 | — |
| ND | — | $245.60 | — |
| NE | — | $291.65 | — |
| NH | — | $245.60 | — |
| NJ | — | $293.60 | — |
| NM | — | $278.14 | — |
| NV | — | $255.91 | — |
| NY | — | $293.60 | — |
| OH | — | $278.40 | — |
| OK | — | $278.14 | — |
| OR | — | $294.95 | — |
| PA | — | $306.30 | — |
| PR | — | $366.25 | — |
| RI | — | $245.60 | — |
| SC | — | $279.11 | — |
| SD | — | $245.60 | — |
| TN | — | $279.11 | — |
| TX | — | $278.14 | — |
| UT | — | $245.60 | — |
| VA | — | $306.30 | — |
| VI | — | $293.60 | — |
| VT | — | $245.60 | — |
| WA | — | $294.95 | — |
| WI | — | $278.40 | — |
| WV | — | $306.30 | — |
| WY | — | $245.60 | — |
How the L8020 fee compares
| Measure | Value |
|---|---|
| Rank among 17 L80 codes (lowest = 1) | 6 |
| Family fee range (average of state fees) | $48.09–$5,112.29 |
| Rural fee uplift | — |
Who bills L8020 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 668 |
| Referring clinicians | 7,529 |
| Medicare beneficiaries | 11,427 |
| States with claims | 48 |
| Share of services in top 3 states (Florida, North Carolina, Texas) | 35% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 771 | 11,855 |
| 2023 | 712 | 12,235 |
| 2024 | 668 | 11,427 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8020, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 18,533 | 11,855 | $228.66 | $176.19 |
| 2023 | 18,977 | 12,235 | $248.00 | $191.05 |
| 2024 | 17,954 | 11,427 | $256.37 | $197.34 |
States with the most L8020 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 2,587 | $201.07 |
| North Carolina | 1,879 | $202.73 |
| Texas | 1,742 | $201.46 |
| Virginia | 1,392 | $219.82 |
| Arkansas | 825 | $197.41 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Clinical: Data |
| outpatient hospital claims | 4 | Clinical: Data |
What changed for L8020
- 2026-01-01: Average state fee rose 2.0%: $271.27 to $276.70
- 1986-01-01: L8020 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 L8020?
L8020 is the HCPCS Level II code for breast prosthesis, mastectomy form. Short descriptor: "Mastectomy form".
How much does Medicare pay for L8020?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $245.60–$366.25. Rural fees can be higher.
Does Medicare cover L8020?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8020 change in 2026?
The average non-rural state fee moved from $271.27 in 2025 to $276.70 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8020 can be billed per day?
4 on DME suppliers; 4 on outpatient hospital claims (NCCI medically unlikely edits).
Related L80 codes
- L8000 — Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type ($44.70–$78.16)
- 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)
- L8030 — Breast prosthesis, silicone or equal, without integral adhesive, any type ($386.23–$514.97)
- L8031 — Breast prosthesis, silicone or equal, with integral adhesive, any type ($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, any type ($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 L8020
- Watch L8020 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8020
Sources: CMS HCPCS Level II release October 2026; 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.