L8035 HCPCS code: Custom breast prosthesis, post mastectomy, molded to patient model, any type
L8035 is the HCPCS Level II code for custom breast prosthesis, post mastectomy, molded to patient model, any type. The 2026 Medicare DMEPOS fee schedule pays $4,403.11 to $5,283.69 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. Its average fee ranks 15 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 | 1999-01-01 |
| Last action effective | 2026-10-01 |
2026 Medicare DMEPOS fee schedule for L8035
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4,403.11 | $5,283.69 | $5,373.34 | $4,030.01 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $4,403.12 | — |
| AL | — | $4,535.66 | — |
| AR | — | $4,535.25 | — |
| AZ | — | $4,403.12 | — |
| CA | — | $4,403.12 | — |
| CO | — | $4,560.69 | — |
| CT | — | $4,403.11 | — |
| DC | — | $4,403.11 | — |
| DE | — | $4,403.11 | — |
| FL | — | $4,535.66 | — |
| GA | — | $4,535.66 | — |
| HI | — | $4,403.12 | — |
| IA | — | $4,489.07 | — |
| ID | — | $4,403.12 | — |
| IL | — | $4,511.21 | — |
| IN | — | $4,511.21 | — |
| KS | — | $4,489.07 | — |
| KY | — | $4,535.66 | — |
| LA | — | $4,535.25 | — |
| MA | — | $4,403.11 | — |
| MD | — | $4,403.11 | — |
| ME | — | $4,403.11 | — |
| MI | — | $4,511.21 | — |
| MN | — | $4,511.21 | — |
| MO | — | $4,489.07 | — |
| MS | — | $4,535.66 | — |
| MT | — | $4,560.69 | — |
| NC | — | $4,535.66 | — |
| ND | — | $4,560.69 | — |
| NE | — | $4,489.07 | — |
| NH | — | $4,403.11 | — |
| NJ | — | $4,403.11 | — |
| NM | — | $4,535.25 | — |
| NV | — | $4,403.12 | — |
| NY | — | $4,403.11 | — |
| OH | — | $4,511.21 | — |
| OK | — | $4,535.25 | — |
| OR | — | $4,403.12 | — |
| PA | — | $4,403.11 | — |
| PR | — | $5,283.69 | — |
| RI | — | $4,403.11 | — |
| SC | — | $4,535.66 | — |
| SD | — | $4,560.69 | — |
| TN | — | $4,535.66 | — |
| TX | — | $4,535.25 | — |
| UT | — | $4,560.69 | — |
| VA | — | $4,403.11 | — |
| VI | — | $5,283.69 | — |
| VT | — | $4,403.11 | — |
| WA | — | $4,403.12 | — |
| WI | — | $4,511.21 | — |
| WV | — | $4,403.11 | — |
| WY | — | $4,560.69 | — |
How the L8035 fee compares
| Measure | Value |
|---|---|
| Rank among 17 L80 codes (lowest = 1) | 15 |
| Family fee range (average of state fees) | $48.09–$5,112.29 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Anatomic Consideration |
| outpatient hospital claims | 2 | Anatomic Consideration |
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 L8035
- October 2026: Descriptor revised (Was: Custom breast prosthesis, post mastectomy, molded to patient model)
- 2026-10-01: Last CMS action: long description changed
- 2026-01-01: Average state fee rose 2.0%: $4,417.04 to $4,505.38
- 1999-01-01: L8035 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 L8035?
L8035 is the HCPCS Level II code for custom breast prosthesis, post mastectomy, molded to patient model, any type. Short descriptor: "Custom breast prosth any".
How much does Medicare pay for L8035?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4,403.11–$5,283.69. Rural fees can be higher.
Does Medicare cover L8035?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for L8035?
Medicare policy articles that cite L8035 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 L8035 change in 2026?
The average non-rural state fee moved from $4,417.04 in 2025 to $4,505.38 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8035 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)
- 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
- 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 L8035
- Watch L8035 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8035
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.