L8043 HCPCS code: Upper facial prosthesis, provided by a non-physician
L8043 is the HCPCS Level II code for upper facial prosthesis, provided by a non-physician. The 2026 Medicare DMEPOS fee schedule pays $4,266.20 to $5,426.13 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. Its average fee ranks 16 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 L8043
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $4,266.20 | $5,426.13 | $5,510.04 | $4,132.53 |
| KM | prosthetics and orthotics | $4,052.87 | $5,154.84 | $5,234.53 | $3,925.90 |
| KN | prosthetics and orthotics | $1,706.46 | $2,170.48 | $2,204.00 | $1,653.00 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $5,117.31 | — |
| AL | — | $4,539.05 | — |
| AR | — | $4,475.52 | — |
| AZ | — | $4,775.50 | — |
| CA | — | $4,775.50 | — |
| CO | — | $4,361.65 | — |
| CT | — | $4,879.09 | — |
| DC | — | $4,646.49 | — |
| DE | — | $4,646.49 | — |
| FL | — | $4,539.05 | — |
| GA | — | $4,539.05 | — |
| HI | — | $4,899.45 | — |
| IA | — | $4,266.20 | — |
| ID | — | $4,557.98 | — |
| IL | — | $4,630.01 | — |
| IN | — | $4,630.01 | — |
| KS | — | $4,266.20 | — |
| KY | — | $4,539.05 | — |
| LA | — | $4,475.52 | — |
| MA | — | $4,879.09 | — |
| MD | — | $4,646.49 | — |
| ME | — | $4,879.09 | — |
| MI | — | $4,630.01 | — |
| MN | — | $4,630.01 | — |
| MO | — | $4,266.20 | — |
| MS | — | $4,539.05 | — |
| MT | — | $4,361.65 | — |
| NC | — | $4,539.05 | — |
| ND | — | $4,361.65 | — |
| NE | — | $4,266.20 | — |
| NH | — | $4,879.09 | — |
| NJ | — | $5,067.31 | — |
| NM | — | $4,475.52 | — |
| NV | — | $4,775.50 | — |
| NY | — | $5,067.31 | — |
| OH | — | $4,630.01 | — |
| OK | — | $4,475.52 | — |
| OR | — | $4,557.98 | — |
| PA | — | $4,646.49 | — |
| PR | — | $4,295.38 | — |
| RI | — | $4,879.09 | — |
| SC | — | $4,539.05 | — |
| SD | — | $4,361.65 | — |
| TN | — | $4,539.05 | — |
| TX | — | $4,475.52 | — |
| UT | — | $4,361.65 | — |
| VA | — | $4,646.49 | — |
| VI | — | $5,426.13 | — |
| VT | — | $4,879.09 | — |
| WA | — | $4,557.98 | — |
| WI | — | $4,630.01 | — |
| WV | — | $4,646.49 | — |
| WY | — | $4,361.65 | — |
| AK | KM | $4,861.43 | — |
| AL | KM | $4,312.05 | — |
| AR | KM | $4,251.77 | — |
| AZ | KM | $4,536.69 | — |
| CA | KM | $4,536.69 | — |
| CO | KM | $4,143.54 | — |
| CT | KM | $4,635.15 | — |
| DC | KM | $4,414.16 | — |
| DE | KM | $4,414.16 | — |
| FL | KM | $4,312.05 | — |
| GA | KM | $4,312.05 | — |
| HI | KM | $4,654.46 | — |
| IA | KM | $4,052.87 | — |
| ID | KM | $4,330.09 | — |
| IL | KM | $4,398.54 | — |
| IN | KM | $4,398.54 | — |
| KS | KM | $4,052.87 | — |
| KY | KM | $4,312.05 | — |
| LA | KM | $4,251.77 | — |
| MA | KM | $4,635.15 | — |
| MD | KM | $4,414.16 | — |
| ME | KM | $4,635.15 | — |
| MI | KM | $4,398.54 | — |
| MN | KM | $4,398.54 | — |
| MO | KM | $4,052.87 | — |
| MS | KM | $4,312.05 | — |
| MT | KM | $4,143.54 | — |
| NC | KM | $4,312.05 | — |
| ND | KM | $4,143.54 | — |
| NE | KM | $4,052.87 | — |
| NH | KM | $4,635.15 | — |
| NJ | KM | $4,813.90 | — |
| NM | KM | $4,251.77 | — |
| NV | KM | $4,536.69 | — |
| NY | KM | $4,813.90 | — |
| OH | KM | $4,398.54 | — |
| OK | KM | $4,251.77 | — |
| OR | KM | $4,330.09 | — |
| PA | KM | $4,414.16 | — |
| PR | KM | $4,080.61 | — |
| RI | KM | $4,635.15 | — |
| SC | KM | $4,312.05 | — |
| SD | KM | $4,143.54 | — |
| TN | KM | $4,312.05 | — |
| TX | KM | $4,251.77 | — |
| UT | KM | $4,143.54 | — |
| VA | KM | $4,414.16 | — |
| VI | KM | $5,154.84 | — |
| VT | KM | $4,635.15 | — |
| WA | KM | $4,330.09 | — |
| WI | KM | $4,398.54 | — |
| WV | KM | $4,414.16 | — |
| WY | KM | $4,143.54 | — |
| AK | KN | $2,046.90 | — |
| AL | KN | $1,815.60 | — |
| AR | KN | $1,790.23 | — |
| AZ | KN | $1,910.16 | — |
| CA | KN | $1,910.16 | — |
| CO | KN | $1,744.62 | — |
| CT | KN | $1,951.61 | — |
| DC | KN | $1,858.57 | — |
| DE | KN | $1,858.57 | — |
| FL | KN | $1,815.60 | — |
| GA | KN | $1,815.60 | — |
| HI | KN | $1,959.80 | — |
| IA | KN | $1,706.46 | — |
| ID | KN | $1,823.20 | — |
| IL | KN | $1,852.02 | — |
| IN | KN | $1,852.02 | — |
| KS | KN | $1,706.46 | — |
| KY | KN | $1,815.60 | — |
| LA | KN | $1,790.23 | — |
| MA | KN | $1,951.61 | — |
| MD | KN | $1,858.57 | — |
| ME | KN | $1,951.61 | — |
| MI | KN | $1,852.02 | — |
| MN | KN | $1,852.02 | — |
| MO | KN | $1,706.46 | — |
| MS | KN | $1,815.60 | — |
| MT | KN | $1,744.62 | — |
| NC | KN | $1,815.60 | — |
| ND | KN | $1,744.62 | — |
| NE | KN | $1,706.46 | — |
| NH | KN | $1,951.61 | — |
| NJ | KN | $2,026.95 | — |
| NM | KN | $1,790.23 | — |
| NV | KN | $1,910.16 | — |
| NY | KN | $2,026.95 | — |
| OH | KN | $1,852.02 | — |
| OK | KN | $1,790.23 | — |
| OR | KN | $1,823.20 | — |
| PA | KN | $1,858.57 | — |
| PR | KN | $1,718.16 | — |
| RI | KN | $1,951.61 | — |
| SC | KN | $1,815.60 | — |
| SD | KN | $1,744.62 | — |
| TN | KN | $1,815.60 | — |
| TX | KN | $1,790.23 | — |
| UT | KN | $1,744.62 | — |
| VA | KN | $1,858.57 | — |
| VI | KN | $2,170.48 | — |
| VT | KN | $1,951.61 | — |
| WA | KN | $1,823.20 | — |
| WI | KN | $1,852.02 | — |
| WV | KN | $1,858.57 | — |
| WY | KN | $1,744.62 | — |
How the L8043 fee compares
| Measure | Value |
|---|---|
| Rank among 17 L80 codes (lowest = 1) | 16 |
| 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 | 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 L8043
- 2026-01-01: Average state fee rose 2.0%: $4,527.04 to $4,617.58
- 2026-01-01: Average state fee (KM) rose 2.0%: $4,300.68 to $4,386.69
- 2026-01-01: Average state fee (KN) rose 2.0%: $1,810.80 to $1,847.02
- 2001-01-01: L8043 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 L8043?
L8043 is the HCPCS Level II code for upper facial prosthesis, provided by a non-physician. Short descriptor: "Upper facial prosthesis".
How much does Medicare pay for L8043?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $4,266.20–$5,426.13; KM (prosthetics and orthotics): $4,052.87–$5,154.84; KN (prosthetics and orthotics): $1,706.46–$2,170.48. Rural fees can be higher.
Does Medicare cover L8043?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L8043 change in 2026?
The average non-rural state fee moved from $4,527.04 in 2025 to $4,617.58 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8043 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 ($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
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Next steps
- Run a reimbursement report for a device billed under L8043
- Watch L8043 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8043
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.