L8041 HCPCS code: Midfacial prosthesis, provided by a non-physician
L8041 is the HCPCS Level II code for midfacial prosthesis, provided by a non-physician. The 2026 Medicare DMEPOS fee schedule pays $3,390.11 to $4,311.87 depending on the state. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on DME suppliers. Medicare volume rose 13% from 2022 to 2024 (15 to 17 services). In 2024, 7 suppliers billed Medicare for L8041 (purchases), serving 15 beneficiaries. Its average fee ranks 13 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 | C — Carrier judgment |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2001-01-01 |
| Last action effective | 2001-01-01 |
2026 Medicare DMEPOS fee schedule for L8041
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $3,390.11 | $4,311.87 | $4,378.51 | $3,283.88 |
| KM | prosthetics and orthotics | $3,220.58 | $4,096.29 | $4,159.57 | $3,119.68 |
| KN | prosthetics and orthotics | $1,356.04 | $1,724.76 | $1,751.41 | $1,313.56 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $4,066.42 | — |
| AL | — | $3,606.94 | — |
| AR | — | $3,556.45 | — |
| AZ | — | $3,794.81 | — |
| CA | — | $3,794.81 | — |
| CO | — | $3,465.95 | — |
| CT | — | $3,877.12 | — |
| DC | — | $3,692.26 | — |
| DE | — | $3,692.26 | — |
| FL | — | $3,606.94 | — |
| GA | — | $3,606.94 | — |
| HI | — | $3,893.35 | — |
| IA | — | $3,390.11 | — |
| ID | — | $3,622.02 | — |
| IL | — | $3,679.20 | — |
| IN | — | $3,679.20 | — |
| KS | — | $3,390.11 | — |
| KY | — | $3,606.94 | — |
| LA | — | $3,556.45 | — |
| MA | — | $3,877.12 | — |
| MD | — | $3,692.26 | — |
| ME | — | $3,877.12 | — |
| MI | — | $3,679.20 | — |
| MN | — | $3,679.20 | — |
| MO | — | $3,390.11 | — |
| MS | — | $3,606.94 | — |
| MT | — | $3,465.95 | — |
| NC | — | $3,606.94 | — |
| ND | — | $3,465.95 | — |
| NE | — | $3,390.11 | — |
| NH | — | $3,877.12 | — |
| NJ | — | $4,026.69 | — |
| NM | — | $3,556.45 | — |
| NV | — | $3,794.81 | — |
| NY | — | $4,026.69 | — |
| OH | — | $3,679.20 | — |
| OK | — | $3,556.45 | — |
| OR | — | $3,622.02 | — |
| PA | — | $3,692.26 | — |
| PR | — | $3,413.33 | — |
| RI | — | $3,877.12 | — |
| SC | — | $3,606.94 | — |
| SD | — | $3,465.95 | — |
| TN | — | $3,606.94 | — |
| TX | — | $3,556.45 | — |
| UT | — | $3,465.95 | — |
| VA | — | $3,692.26 | — |
| VI | — | $4,311.87 | — |
| VT | — | $3,877.12 | — |
| WA | — | $3,622.02 | — |
| WI | — | $3,679.20 | — |
| WV | — | $3,692.26 | — |
| WY | — | $3,465.95 | — |
| AK | KM | $3,863.11 | — |
| AL | KM | $3,426.59 | — |
| AR | KM | $3,378.62 | — |
| AZ | KM | $3,605.07 | — |
| CA | KM | $3,605.07 | — |
| CO | KM | $3,292.65 | — |
| CT | KM | $3,683.28 | — |
| DC | KM | $3,507.63 | — |
| DE | KM | $3,507.63 | — |
| FL | KM | $3,426.59 | — |
| GA | KM | $3,426.59 | — |
| HI | KM | $3,698.63 | — |
| IA | KM | $3,220.58 | — |
| ID | KM | $3,440.86 | — |
| IL | KM | $3,495.19 | — |
| IN | KM | $3,495.19 | — |
| KS | KM | $3,220.58 | — |
| KY | KM | $3,426.59 | — |
| LA | KM | $3,378.62 | — |
| MA | KM | $3,683.28 | — |
| MD | KM | $3,507.63 | — |
| ME | KM | $3,683.28 | — |
| MI | KM | $3,495.19 | — |
| MN | KM | $3,495.19 | — |
| MO | KM | $3,220.58 | — |
| MS | KM | $3,426.59 | — |
| MT | KM | $3,292.65 | — |
| NC | KM | $3,426.59 | — |
| ND | KM | $3,292.65 | — |
| NE | KM | $3,220.58 | — |
| NH | KM | $3,683.28 | — |
| NJ | KM | $3,825.34 | — |
| NM | KM | $3,378.62 | — |
| NV | KM | $3,605.07 | — |
| NY | KM | $3,825.34 | — |
| OH | KM | $3,495.19 | — |
| OK | KM | $3,378.62 | — |
| OR | KM | $3,440.86 | — |
| PA | KM | $3,507.63 | — |
| PR | KM | $3,242.65 | — |
| RI | KM | $3,683.28 | — |
| SC | KM | $3,426.59 | — |
| SD | KM | $3,292.65 | — |
| TN | KM | $3,426.59 | — |
| TX | KM | $3,378.62 | — |
| UT | KM | $3,292.65 | — |
| VA | KM | $3,507.63 | — |
| VI | KM | $4,096.29 | — |
| VT | KM | $3,683.28 | — |
| WA | KM | $3,440.86 | — |
| WI | KM | $3,495.19 | — |
| WV | KM | $3,507.63 | — |
| WY | KM | $3,292.65 | — |
| AK | KN | $1,626.57 | — |
| AL | KN | $1,442.78 | — |
| AR | KN | $1,422.56 | — |
| AZ | KN | $1,517.97 | — |
| CA | KN | $1,517.97 | — |
| CO | KN | $1,386.36 | — |
| CT | KN | $1,550.86 | — |
| DC | KN | $1,476.93 | — |
| DE | KN | $1,476.93 | — |
| FL | KN | $1,442.78 | — |
| GA | KN | $1,442.78 | — |
| HI | KN | $1,557.32 | — |
| IA | KN | $1,356.04 | — |
| ID | KN | $1,448.81 | — |
| IL | KN | $1,471.71 | — |
| IN | KN | $1,471.71 | — |
| KS | KN | $1,356.04 | — |
| KY | KN | $1,442.78 | — |
| LA | KN | $1,422.56 | — |
| MA | KN | $1,550.86 | — |
| MD | KN | $1,476.93 | — |
| ME | KN | $1,550.86 | — |
| MI | KN | $1,471.71 | — |
| MN | KN | $1,471.71 | — |
| MO | KN | $1,356.04 | — |
| MS | KN | $1,442.78 | — |
| MT | KN | $1,386.36 | — |
| NC | KN | $1,442.78 | — |
| ND | KN | $1,386.36 | — |
| NE | KN | $1,356.04 | — |
| NH | KN | $1,550.86 | — |
| NJ | KN | $1,610.68 | — |
| NM | KN | $1,422.56 | — |
| NV | KN | $1,517.97 | — |
| NY | KN | $1,610.68 | — |
| OH | KN | $1,471.71 | — |
| OK | KN | $1,422.56 | — |
| OR | KN | $1,448.81 | — |
| PA | KN | $1,476.93 | — |
| PR | KN | $1,365.32 | — |
| RI | KN | $1,550.86 | — |
| SC | KN | $1,442.78 | — |
| SD | KN | $1,386.36 | — |
| TN | KN | $1,442.78 | — |
| TX | KN | $1,422.56 | — |
| UT | KN | $1,386.36 | — |
| VA | KN | $1,476.93 | — |
| VI | KN | $1,724.76 | — |
| VT | KN | $1,550.86 | — |
| WA | KN | $1,448.81 | — |
| WI | KN | $1,471.71 | — |
| WV | KN | $1,476.93 | — |
| WY | KN | $1,386.36 | — |
How the L8041 fee compares
| Measure | Value |
|---|---|
| Rank among 17 L80 codes (lowest = 1) | 13 |
| Family fee range (average of state fees) | $48.09–$5,112.29 |
| Rural fee uplift | — |
Who bills L8041 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 7 |
| Referring clinicians | 14 |
| Medicare beneficiaries | 15 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 6 | 14 |
| 2024 | 7 | 15 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8041, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 15 | 14 | $3,090.03 | $2,437.17 |
| 2024 | 17 | 15 | $3,475.88 | $2,725.09 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1 | Anatomic Consideration |
| outpatient hospital claims | 1 | Anatomic Consideration |
Medicare policy articles for this code
- A52463: Facial Prostheses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
What changed for L8041
- 2026-01-01: Average state fee rose 2.0%: $3,597.38 to $3,669.33
- 2026-01-01: Average state fee (KM) rose 2.0%: $3,417.49 to $3,485.85
- 2026-01-01: Average state fee (KN) rose 2.0%: $1,438.96 to $1,467.74
- 2001-01-01: L8041 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 L8041?
L8041 is the HCPCS Level II code for midfacial prosthesis, provided by a non-physician. Short descriptor: "Midfacial prosthesis".
How much does Medicare pay for L8041?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $3,390.11–$4,311.87; KM (prosthetics and orthotics): $3,220.58–$4,096.29; KN (prosthetics and orthotics): $1,356.04–$1,724.76. Rural fees can be higher.
Does Medicare cover L8041?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L8041 change in 2026?
The average non-rural state fee moved from $3,597.38 in 2025 to $3,669.33 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8041 can be billed per day?
1 on DME suppliers; 1 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
- L8035 — Custom breast prosthesis, post mastectomy, molded to patient model, any type ($4,403.11–$5,283.69)
- L8039 — Breast prosthesis, not otherwise specified
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 L8041
- Watch L8041 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8041
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.