L8030 HCPCS code: Breast prosthesis, silicone or equal, without integral adhesive
L8030 is the HCPCS Level II code for breast prosthesis, silicone or equal, without integral adhesive. The 2026 Medicare DMEPOS fee schedule pays $386.23 to $514.97 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 2 per day on DME suppliers. Medicare volume fell 11% from 2022 to 2024 (59,826 to 53,383 services). In 2024, 1,367 suppliers billed Medicare for L8030 (purchases), serving 42,844 beneficiaries; California, Florida, Pennsylvania accounted for 20% of services. Its average fee ranks 7 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 | 1989-01-01 |
| Last action effective | 2010-01-01 |
2026 Medicare DMEPOS fee schedule for L8030
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $386.23 | $514.97 | $514.97 | $386.23 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $475.07 | — |
| AL | — | $403.72 | — |
| AR | — | $408.38 | — |
| AZ | — | $467.55 | — |
| CA | — | $467.55 | — |
| CO | — | $435.83 | — |
| CT | — | $514.97 | — |
| DC | — | $396.42 | — |
| DE | — | $396.42 | — |
| FL | — | $403.72 | — |
| GA | — | $403.72 | — |
| HI | — | $508.01 | — |
| IA | — | $436.55 | — |
| ID | — | $386.23 | — |
| IL | — | $430.39 | — |
| IN | — | $430.39 | — |
| KS | — | $436.55 | — |
| KY | — | $403.72 | — |
| LA | — | $408.38 | — |
| MA | — | $514.97 | — |
| MD | — | $396.42 | — |
| ME | — | $514.97 | — |
| MI | — | $430.39 | — |
| MN | — | $430.39 | — |
| MO | — | $436.55 | — |
| MS | — | $403.72 | — |
| MT | — | $435.83 | — |
| NC | — | $403.72 | — |
| ND | — | $435.83 | — |
| NE | — | $436.55 | — |
| NH | — | $514.97 | — |
| NJ | — | $395.95 | — |
| NM | — | $408.38 | — |
| NV | — | $467.55 | — |
| NY | — | $395.95 | — |
| OH | — | $430.39 | — |
| OK | — | $408.38 | — |
| OR | — | $386.23 | — |
| PA | — | $396.42 | — |
| PR | — | $413.48 | — |
| RI | — | $514.97 | — |
| SC | — | $403.72 | — |
| SD | — | $435.83 | — |
| TN | — | $403.72 | — |
| TX | — | $408.38 | — |
| UT | — | $435.83 | — |
| VA | — | $396.42 | — |
| VI | — | $395.95 | — |
| VT | — | $514.97 | — |
| WA | — | $386.23 | — |
| WI | — | $430.39 | — |
| WV | — | $396.42 | — |
| WY | — | $435.83 | — |
How the L8030 fee compares
| Measure | Value |
|---|---|
| Rank among 17 L80 codes (lowest = 1) | 7 |
| Family fee range (average of state fees) | $48.09–$5,112.29 |
| Rural fee uplift | — |
Who bills L8030 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 1,367 |
| Referring clinicians | 25,825 |
| Medicare beneficiaries | 42,844 |
| States with claims | 52 |
| Share of services in top 3 states (California, Florida, Pennsylvania) | 20% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 1,579 | 48,688 |
| 2023 | 1,463 | 46,830 |
| 2024 | 1,367 | 42,844 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8030, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 59,826 | 48,688 | $355.06 | $272.89 |
| 2023 | 57,776 | 46,830 | $384.08 | $294.63 |
| 2024 | 53,383 | 42,844 | $396.46 | $304.51 |
States with the most L8030 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 4,129 | $335.63 |
| Florida | 3,663 | $296.60 |
| Pennsylvania | 2,685 | $285.93 |
| New York | 2,418 | $283.92 |
| Texas | 2,364 | $299.02 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
What changed for L8030
- 2026-01-01: Average state fee rose 2.0%: $422.29 to $430.74
- 1989-01-01: L8030 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 L8030?
L8030 is the HCPCS Level II code for breast prosthesis, silicone or equal, without integral adhesive. Short descriptor: "Breast prosthes w/o adhesive".
How much does Medicare pay for L8030?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $386.23–$514.97. Rural fees can be higher.
Does Medicare cover L8030?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8030 change in 2026?
The average non-rural state fee moved from $422.29 in 2025 to $430.74 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8030 can be billed per day?
2 on DME suppliers; 2 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)
- L8020 — Breast prosthesis, mastectomy form ($245.60–$366.25)
- 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 L8030
- Watch L8030 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8030
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.