L8642 HCPCS code: Hallux implant
L8642 is the HCPCS Level II code for hallux implant. The 2026 Medicare DMEPOS fee schedule pays $347.59 to $463.46 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. Medicare volume rose 33% from 2022 to 2023 (12 to 16 services). In 2023, about 1 clinicians billed Medicare for L8642 for 16 beneficiaries. Its average fee ranks 16 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 L8642
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $347.59 | $463.46 | $463.46 | $347.59 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AL | — | $367.48 | — |
| AR | — | $356.35 | — |
| AZ | — | $424.07 | — |
| CA | — | $424.07 | — |
| CO | — | $374.00 | — |
| CT | — | $347.59 | — |
| DC | — | $400.15 | — |
| DE | — | $400.15 | — |
| FL | — | $367.48 | — |
| GA | — | $367.48 | — |
| IA | — | $463.46 | — |
| ID | — | $376.00 | — |
| IL | — | $383.18 | — |
| IN | — | $383.18 | — |
| KS | — | $463.46 | — |
| KY | — | $367.48 | — |
| LA | — | $356.35 | — |
| MA | — | $347.59 | — |
| MD | — | $400.15 | — |
| ME | — | $347.59 | — |
| MI | — | $383.18 | — |
| MN | — | $383.18 | — |
| MO | — | $463.46 | — |
| MS | — | $367.48 | — |
| MT | — | $374.00 | — |
| NC | — | $367.48 | — |
| ND | — | $374.00 | — |
| NE | — | $463.46 | — |
| NH | — | $347.59 | — |
| NJ | — | $375.67 | — |
| NM | — | $356.35 | — |
| NV | — | $424.07 | — |
| NY | — | $375.67 | — |
| OH | — | $383.18 | — |
| OK | — | $356.35 | — |
| OR | — | $376.00 | — |
| PA | — | $400.15 | — |
| RI | — | $347.59 | — |
| SC | — | $367.48 | — |
| SD | — | $374.00 | — |
| TN | — | $367.48 | — |
| TX | — | $356.35 | — |
| UT | — | $374.00 | — |
| VA | — | $400.15 | — |
| VT | — | $347.59 | — |
| WA | — | $376.00 | — |
| WI | — | $383.18 | — |
| WV | — | $400.15 | — |
| WY | — | $374.00 | — |
How the L8642 fee compares
| Measure | Value |
|---|---|
| Rank among 43 L86 codes (lowest = 1) | 16 |
| Family fee range (average of state fees) | $0.40–$23,640.75 |
| Rural fee uplift | — |
Who bills L8642 (2023)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1 |
| Medicare beneficiaries | 16 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for L8642, 2022–2023
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 12 | 12 | $360.65 | $287.85 |
| 2023 | 16 | 16 | $389.39 | $310.25 |
States with the most L8642 services (2023)
| State | Services | Avg. paid |
|---|---|---|
| California | 16 | $310.25 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Anatomic Consideration |
| practitioner claims | 2 | Anatomic Consideration |
What changed for L8642
- 2026-01-01: Average state fee rose 2.0%: $375.28 to $382.79
- 1992-01-01: L8642 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 L8642?
L8642 is the HCPCS Level II code for hallux implant. Short descriptor: "Hallux implant".
How much does Medicare pay for L8642?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $347.59–$463.46. Rural fees can be higher.
Does Medicare cover L8642?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for L8642 change in 2026?
The average non-rural state fee moved from $375.28 in 2025 to $382.79 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of L8642 can be billed per day?
2 on outpatient hospital claims; 2 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)
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 L8642
- Watch L8642 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for L8642
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.