L8509 HCPCS code: Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type
L8509 is the HCPCS Level II code for tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type. The 2026 Medicare DMEPOS fee schedule pays $131.24 to $144.37 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 outpatient hospital claims. Medicare volume rose 9% from 2022 to 2024 (987 to 1,071 services). In 2024, about 103 clinicians billed Medicare for L8509 for 419 beneficiaries; Pennsylvania, Minnesota, Arizona accounted for 40% of services. Its average fee ranks 7 of 10 L85 codes (family range $2.66–$885.39).
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 | 2002-01-01 |
| Last action effective | 2002-01-01 |
2026 Medicare DMEPOS fee schedule for L8509
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $131.24 | $144.37 | $160.17 | $120.13 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $131.24 | — |
| AL | — | $135.22 | — |
| AR | — | $135.20 | — |
| AZ | — | $131.24 | — |
| CA | — | $131.24 | — |
| CO | — | $135.93 | — |
| CT | — | $131.24 | — |
| DC | — | $131.24 | — |
| DE | — | $131.24 | — |
| FL | — | $135.22 | — |
| GA | — | $135.22 | — |
| HI | — | $131.24 | — |
| IA | — | $133.79 | — |
| ID | — | $131.24 | — |
| IL | — | $134.48 | — |
| IN | — | $134.48 | — |
| KS | — | $133.79 | — |
| KY | — | $135.22 | — |
| LA | — | $135.20 | — |
| MA | — | $131.24 | — |
| MD | — | $131.24 | — |
| ME | — | $131.24 | — |
| MI | — | $134.48 | — |
| MN | — | $134.48 | — |
| MO | — | $133.79 | — |
| MS | — | $135.22 | — |
| MT | — | $135.93 | — |
| NC | — | $135.22 | — |
| ND | — | $135.93 | — |
| NE | — | $133.79 | — |
| NH | — | $131.24 | — |
| NJ | — | $131.24 | — |
| NM | — | $135.20 | — |
| NV | — | $131.24 | — |
| NY | — | $131.24 | — |
| OH | — | $134.48 | — |
| OK | — | $135.20 | — |
| OR | — | $131.24 | — |
| PA | — | $131.24 | — |
| PR | — | $144.37 | — |
| RI | — | $131.24 | — |
| SC | — | $135.22 | — |
| SD | — | $135.93 | — |
| TN | — | $135.22 | — |
| TX | — | $135.20 | — |
| UT | — | $135.93 | — |
| VA | — | $131.24 | — |
| VI | — | $144.37 | — |
| VT | — | $131.24 | — |
| WA | — | $131.24 | — |
| WI | — | $134.48 | — |
| WV | — | $131.24 | — |
| WY | — | $135.93 | — |
How the L8509 fee compares
| Measure | Value |
|---|---|
| Rank among 10 L85 codes (lowest = 1) | 7 |
| Family fee range (average of state fees) | $2.66–$885.39 |
| Rural fee uplift | — |
Who bills L8509 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 103 |
| Medicare beneficiaries | 419 |
| States with claims | 15 |
| Share of services in top 3 states (Pennsylvania, Minnesota, Arizona) | 40% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8509, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 987 | 354 | $112.58 | $84.39 |
| 2023 | 1,019 | 388 | $116.13 | $87.84 |
| 2024 | 1,071 | 419 | $118.68 | $89.87 |
States with the most L8509 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Pennsylvania | 204 | $92.87 |
| Minnesota | 97 | $94.61 |
| Arizona | 86 | $92.78 |
| Illinois | 85 | $91.99 |
| Missouri | 72 | $94.60 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Anatomic Consideration |
| practitioner claims | 1 | Anatomic Consideration |
What changed for L8509
- 2026-01-01: Average state fee rose 2.0%: $131.18 to $133.80
- 2002-01-01: L8509 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 L8509?
L8509 is the HCPCS Level II code for tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type. Short descriptor: "Trach-esoph voice pros md in".
How much does Medicare pay for L8509?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $131.24–$144.37. Rural fees can be higher.
Does Medicare cover L8509?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Did the Medicare fee for L8509 change in 2026?
The average non-rural state fee moved from $131.18 in 2025 to $133.80 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8509 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related L85 codes
- L8500 — Artificial larynx, any type ($704.63–$1,077.27)
- L8501 — Tracheostomy speaking valve ($107.37–$197.18)
- L8505 — Artificial larynx replacement battery / accessory, any type
- L8507 — Tracheo-esophageal voice prosthesis, patient inserted, any type, each ($50.34–$55.40)
- L8510 — Voice amplifier ($303.69–$334.05)
- L8511 — Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each ($87.41–$104.86)
- L8512 — Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 ($2.59–$3.12)
- L8513 — Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each ($6.24–$7.46)
- L8514 — Tracheoesophageal puncture dilator, replacement only, each ($113.31–$136.01)
- L8515 — Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each ($75.84–$83.45)
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 L8509
- Watch L8509 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8509
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.