L8415 HCPCS code: Prosthetic sheath, upper limb, each
L8415 is the HCPCS Level II code for prosthetic sheath, upper limb, each. The 2026 Medicare DMEPOS fee schedule pays $26.24 to $34.99 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 6 per day on DME suppliers. Medicare volume fell 1% from 2022 to 2024 (175 to 173 services). In 2024, 27 suppliers billed Medicare for L8415 (purchases), serving 28 beneficiaries. Its average fee ranks 7 of 13 L84 codes (family range $8.84–$92.93).
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 | 1988-01-01 |
| Last action effective | 1996-01-01 |
2026 Medicare DMEPOS fee schedule for L8415
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $26.24 | $34.99 | $34.99 | $26.24 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $30.04 | — |
| AL | — | $26.24 | — |
| AR | — | $28.64 | — |
| AZ | — | $29.31 | — |
| CA | — | $29.31 | — |
| CO | — | $28.98 | — |
| CT | — | $34.99 | — |
| DC | — | $27.93 | — |
| DE | — | $27.93 | — |
| FL | — | $26.24 | — |
| GA | — | $26.24 | — |
| HI | — | $32.14 | — |
| IA | — | $29.77 | — |
| ID | — | $33.23 | — |
| IL | — | $26.24 | — |
| IN | — | $26.24 | — |
| KS | — | $29.77 | — |
| KY | — | $26.24 | — |
| LA | — | $28.64 | — |
| MA | — | $34.99 | — |
| MD | — | $27.93 | — |
| ME | — | $34.99 | — |
| MI | — | $26.24 | — |
| MN | — | $26.24 | — |
| MO | — | $29.77 | — |
| MS | — | $26.24 | — |
| MT | — | $28.98 | — |
| NC | — | $26.24 | — |
| ND | — | $28.98 | — |
| NE | — | $29.77 | — |
| NH | — | $34.99 | — |
| NJ | — | $29.43 | — |
| NM | — | $28.64 | — |
| NV | — | $29.31 | — |
| NY | — | $29.43 | — |
| OH | — | $26.24 | — |
| OK | — | $28.64 | — |
| OR | — | $33.23 | — |
| PA | — | $27.93 | — |
| PR | — | $31.01 | — |
| RI | — | $34.99 | — |
| SC | — | $26.24 | — |
| SD | — | $28.98 | — |
| TN | — | $26.24 | — |
| TX | — | $28.64 | — |
| UT | — | $28.98 | — |
| VA | — | $27.93 | — |
| VI | — | $29.43 | — |
| VT | — | $34.99 | — |
| WA | — | $33.23 | — |
| WI | — | $26.24 | — |
| WV | — | $27.93 | — |
| WY | — | $28.98 | — |
How the L8415 fee compares
| Measure | Value |
|---|---|
| Rank among 13 L84 codes (lowest = 1) | 7 |
| Family fee range (average of state fees) | $8.84–$92.93 |
| Rural fee uplift | — |
Who bills L8415 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 27 |
| Referring clinicians | 28 |
| Medicare beneficiaries | 28 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 31 | 33 |
| 2023 | 31 | 31 |
| 2024 | 27 | 28 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8415, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 175 | 33 | $24.58 | $19.23 |
| 2023 | 186 | 31 | $26.36 | $20.05 |
| 2024 | 173 | 28 | $28.23 | $21.28 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | Clinical: Data |
| outpatient hospital claims | 6 | Clinical: CMS Workgroup |
What changed for L8415
- 2026-01-01: Average state fee rose 2.0%: $28.68 to $29.25
- 1988-01-01: L8415 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 L8415?
L8415 is the HCPCS Level II code for prosthetic sheath, upper limb, each. Short descriptor: "Sheath upper limb".
How much does Medicare pay for L8415?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $26.24–$34.99. Rural fees can be higher.
Does Medicare cover L8415?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8415 change in 2026?
The average non-rural state fee moved from $28.68 in 2025 to $29.25 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8415 can be billed per day?
6 on DME suppliers; 6 on outpatient hospital claims (NCCI medically unlikely edits).
Related L84 codes
- L8400 — Prosthetic sheath, below knee, each ($19.27–$31.34)
- L8410 — Prosthetic sheath, above knee, each ($25.36–$36.14)
- L8417 — Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each ($90.25–$99.43)
- L8420 — Prosthetic sock, multiple ply, below knee, each ($23.81–$47.61)
- L8430 — Prosthetic sock, multiple ply, above knee, each ($27.10–$47.61)
- L8435 — Prosthetic sock, multiple ply, upper limb, each ($25.74–$35.23)
- L8440 — Prosthetic shrinker, below knee, each ($51.20–$98.92)
- L8460 — Prosthetic shrinker, above knee, each ($81.59–$184.58)
- L8465 — Prosthetic shrinker, upper limb, each ($38.70–$79.62)
- L8470 — Prosthetic sock, single ply, fitting, below knee, each ($4.24–$12.04)
- L8480 — Prosthetic sock, single ply, fitting, above knee, each ($6.28–$15.03)
- L8485 — Prosthetic sock, single ply, fitting, upper limb, each ($13.62–$17.97)
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 L8415
- Watch L8415 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8415
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.