L8631 HCPCS code: Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)
L8631 is the HCPCS Level II code for metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system). The 2026 Medicare DMEPOS fee schedule pays $2,609.08 to $2,768.01 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 35 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 | 2004-01-01 |
| Last action effective | 2004-01-01 |
2026 Medicare DMEPOS fee schedule for L8631
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $2,609.08 | $2,768.01 | $3,227.61 | $2,420.71 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AL | — | $2,768.01 | — |
| AR | — | $2,687.37 | — |
| AZ | — | $2,739.60 | — |
| CA | — | $2,739.60 | — |
| CO | — | $2,702.46 | — |
| CT | — | $2,681.80 | — |
| DC | — | $2,609.08 | — |
| DE | — | $2,609.08 | — |
| FL | — | $2,768.01 | — |
| GA | — | $2,768.01 | — |
| IA | — | $2,660.02 | — |
| ID | — | $2,609.08 | — |
| IL | — | $2,708.74 | — |
| IN | — | $2,708.74 | — |
| KS | — | $2,660.02 | — |
| KY | — | $2,768.01 | — |
| LA | — | $2,687.37 | — |
| MA | — | $2,681.80 | — |
| MD | — | $2,609.08 | — |
| ME | — | $2,681.80 | — |
| MI | — | $2,708.74 | — |
| MN | — | $2,708.74 | — |
| MO | — | $2,660.02 | — |
| MS | — | $2,768.01 | — |
| MT | — | $2,702.46 | — |
| NC | — | $2,768.01 | — |
| ND | — | $2,702.46 | — |
| NE | — | $2,660.02 | — |
| NH | — | $2,681.80 | — |
| NJ | — | $2,657.22 | — |
| NM | — | $2,687.37 | — |
| NV | — | $2,739.60 | — |
| NY | — | $2,657.22 | — |
| OH | — | $2,708.74 | — |
| OK | — | $2,687.37 | — |
| OR | — | $2,609.08 | — |
| PA | — | $2,609.08 | — |
| RI | — | $2,681.80 | — |
| SC | — | $2,768.01 | — |
| SD | — | $2,702.46 | — |
| TN | — | $2,768.01 | — |
| TX | — | $2,687.37 | — |
| UT | — | $2,702.46 | — |
| VA | — | $2,609.08 | — |
| VT | — | $2,681.80 | — |
| WA | — | $2,609.08 | — |
| WI | — | $2,708.74 | — |
| WV | — | $2,609.08 | — |
| WY | — | $2,702.46 | — |
How the L8631 fee compares
| Measure | Value |
|---|---|
| Rank among 43 L86 codes (lowest = 1) | 35 |
| 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 | Clinical: Data |
| practitioner claims | 1 | Clinical: Data |
What changed for L8631
- 2026-01-01: Average state fee rose 2.0%: $2,636.94 to $2,689.67
- 2004-01-01: L8631 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 L8631?
L8631 is the HCPCS Level II code for metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system). Short descriptor: "Mcp joint repl 2 pc or more".
How much does Medicare pay for L8631?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $2,609.08–$2,768.01. Rural fees can be higher.
Does Medicare cover L8631?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8631 change in 2026?
The average non-rural state fee moved from $2,636.94 in 2025 to $2,689.67 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8631 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)
- L8613 — Ossicula implant ($314.80–$418.46)
- L8614 — Cochlear device, includes all internal and external components ($22,998.52–$24,149.06)
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Next steps
- Run a reimbursement report for a device billed under L8631
- Watch L8631 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8631
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.