L8613 HCPCS code: Ossicula implant
L8613 is the HCPCS Level II code for ossicula implant. The 2026 Medicare DMEPOS fee schedule pays $314.80 to $418.46 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 2 per day on outpatient hospital claims. Its average fee ranks 15 of 43 L86 codes (family range $0.40–$23,640.75).
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 | 1992-01-01 |
| Last action effective | 1997-10-01 |
2026 Medicare DMEPOS fee schedule for L8613
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $314.80 | $418.46 | $419.73 | $314.80 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AL | — | $370.27 | — |
| AR | — | $368.50 | — |
| AZ | — | $361.54 | — |
| CA | — | $361.54 | — |
| CO | — | $314.80 | — |
| CT | — | $382.50 | — |
| DC | — | $374.79 | — |
| DE | — | $374.79 | — |
| FL | — | $370.27 | — |
| GA | — | $370.27 | — |
| IA | — | $332.38 | — |
| ID | — | $368.50 | — |
| IL | — | $418.46 | — |
| IN | — | $418.46 | — |
| KS | — | $332.38 | — |
| KY | — | $370.27 | — |
| LA | — | $368.50 | — |
| MA | — | $382.50 | — |
| MD | — | $374.79 | — |
| ME | — | $382.50 | — |
| MI | — | $418.46 | — |
| MN | — | $418.46 | — |
| MO | — | $332.38 | — |
| MS | — | $370.27 | — |
| MT | — | $314.80 | — |
| NC | — | $370.27 | — |
| ND | — | $314.80 | — |
| NE | — | $332.38 | — |
| NH | — | $382.50 | — |
| NJ | — | $410.34 | — |
| NM | — | $368.50 | — |
| NV | — | $361.54 | — |
| NY | — | $410.34 | — |
| OH | — | $418.46 | — |
| OK | — | $368.50 | — |
| OR | — | $368.50 | — |
| PA | — | $374.79 | — |
| RI | — | $382.50 | — |
| SC | — | $370.27 | — |
| SD | — | $314.80 | — |
| TN | — | $370.27 | — |
| TX | — | $368.50 | — |
| UT | — | $314.80 | — |
| VA | — | $374.79 | — |
| VT | — | $382.50 | — |
| WA | — | $368.50 | — |
| WI | — | $418.46 | — |
| WV | — | $374.79 | — |
| WY | — | $314.80 | — |
How the L8613 fee compares
| Measure | Value |
|---|---|
| Rank among 43 L86 codes (lowest = 1) | 15 |
| Family fee range (average of state fees) | $0.40–$23,640.75 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Anatomic Consideration |
| practitioner claims | 1 | Clinical: Data |
What changed for L8613
- 2026-01-01: Average state fee rose 2.0%: $361.91 to $369.15
- 1992-01-01: L8613 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 L8613?
L8613 is the HCPCS Level II code for ossicula implant. Short descriptor: "Ossicular implant".
How much does Medicare pay for L8613?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $314.80–$418.46. Rural fees can be higher.
Does Medicare cover L8613?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8613 change in 2026?
The average non-rural state fee moved from $361.91 in 2025 to $369.15 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8613 can be billed per day?
2 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related L86 codes
- L8600 — Implantable breast prosthesis, silicone or equal ($764.47–$1,019.30)
- L8603 — Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies ($534.60–$539.27)
- L8604 — Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies
- L8605 — Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies ($860.80–$946.86)
- L8606 — Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies ($252.88–$281.84)
- L8607 — Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies ($51.53–$56.69)
- L8608 — Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system
- L8609 — Artificial cornea ($7,830.54–$8,127.00)
- L8610 — Ocular implant ($716.57–$955.43)
- L8612 — Aqueous shunt ($744.39–$974.58)
- L8614 — Cochlear device, includes all internal and external components ($22,998.52–$24,149.06)
- L8615 — Headset/headpiece for use with cochlear implant device, replacement ($542.05–$562.60)
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Next steps
- Run a reimbursement report for a device billed under L8613
- Watch L8613 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8613
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.