L8465 HCPCS code: Prosthetic shrinker, upper limb, each
L8465 is the HCPCS Level II code for prosthetic shrinker, upper limb, each. The 2026 Medicare DMEPOS fee schedule pays $38.70 to $79.62 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 4 per day on DME suppliers. Medicare volume fell 19% from 2022 to 2024 (136 to 110 services). In 2024, 43 suppliers billed Medicare for L8465 (purchases), serving 51 beneficiaries. Its average fee ranks 11 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 L8465
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $38.70 | $79.62 | $79.62 | $59.71 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $52.40 | — |
| AL | — | $79.62 | — |
| AR | — | $67.04 | — |
| AZ | — | $59.71 | — |
| CA | — | $59.71 | — |
| CO | — | $59.71 | — |
| CT | — | $62.74 | — |
| DC | — | $72.23 | — |
| DE | — | $72.23 | — |
| FL | — | $79.62 | — |
| GA | — | $79.62 | — |
| HI | — | $56.07 | — |
| IA | — | $59.71 | — |
| ID | — | $59.71 | — |
| IL | — | $75.41 | — |
| IN | — | $75.41 | — |
| KS | — | $59.71 | — |
| KY | — | $79.62 | — |
| LA | — | $67.04 | — |
| MA | — | $62.74 | — |
| MD | — | $72.23 | — |
| ME | — | $62.74 | — |
| MI | — | $75.41 | — |
| MN | — | $75.41 | — |
| MO | — | $59.71 | — |
| MS | — | $79.62 | — |
| MT | — | $59.71 | — |
| NC | — | $79.62 | — |
| ND | — | $59.71 | — |
| NE | — | $59.71 | — |
| NH | — | $62.74 | — |
| NJ | — | $59.71 | — |
| NM | — | $67.04 | — |
| NV | — | $59.71 | — |
| NY | — | $59.71 | — |
| OH | — | $75.41 | — |
| OK | — | $67.04 | — |
| OR | — | $59.71 | — |
| PA | — | $72.23 | — |
| PR | — | $38.70 | — |
| RI | — | $62.74 | — |
| SC | — | $79.62 | — |
| SD | — | $59.71 | — |
| TN | — | $79.62 | — |
| TX | — | $67.04 | — |
| UT | — | $59.71 | — |
| VA | — | $72.23 | — |
| VI | — | $59.71 | — |
| VT | — | $62.74 | — |
| WA | — | $59.71 | — |
| WI | — | $75.41 | — |
| WV | — | $72.23 | — |
| WY | — | $59.71 | — |
How the L8465 fee compares
| Measure | Value |
|---|---|
| Rank among 13 L84 codes (lowest = 1) | 11 |
| Family fee range (average of state fees) | $8.84–$92.93 |
| Rural fee uplift | — |
Who bills L8465 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 43 |
| Referring clinicians | 49 |
| Medicare beneficiaries | 51 |
| States with claims | 0 |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 54 | 61 |
| 2023 | 52 | 59 |
| 2024 | 43 | 51 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8465, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 136 | 61 | $58.93 | $44.15 |
| 2023 | 142 | 59 | $63.82 | $46.86 |
| 2024 | 110 | 51 | $64.46 | $47.88 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 4 | Clinical: Data |
| outpatient hospital claims | 4 | Clinical: Data |
What changed for L8465
- 2026-01-01: Average state fee rose 2.0%: $65.04 to $66.34
- 1988-01-01: L8465 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 L8465?
L8465 is the HCPCS Level II code for prosthetic shrinker, upper limb, each. Short descriptor: "Shrinker upper limb".
How much does Medicare pay for L8465?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $38.70–$79.62. Rural fees can be higher.
Does Medicare cover L8465?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8465 change in 2026?
The average non-rural state fee moved from $65.04 in 2025 to $66.34 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8465 can be billed per day?
4 on DME suppliers; 4 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)
- L8415 — Prosthetic sheath, upper limb, each ($26.24–$34.99)
- 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)
- 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 L8465
- Watch L8465 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8465
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.