D05.80: Other specified type of carcinoma in situ of unspecified breast

D05.80, other specified type of carcinoma in situ of unspecified breast, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 30 HCPCS Level II codes, including L8035 (Custom breast prosthesis, post mastectomy, molded to…), L8002 (Breast prosthesis, mastectomy bra, with integrated breast…), L8001 (Breast prosthesis, mastectomy bra, with integrated breast…). 6 of these codes have a 2026 DMEPOS fee schedule amount; L8035 pays $4,403.11 to $5,283.69 depending on the state. The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.

HCPCS Level II codes with D05.80 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
L8035Custom breast prosthesis, post mastectomy, molded to patient model, any typeSpecial coverage instructions apply$4,403.11–$5,283.691
L8002Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any typeSpecial coverage instructions apply$198.27–$218.121
L8001Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any typeSpecial coverage instructions apply$150.77–$165.831
L8015External breast prosthesis garment, with mastectomy form, post mastectomySpecial coverage instructions apply$72.05–$86.411
L8000Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any typeSpecial coverage instructions apply$44.70–$78.161
A4280Adhesive skin support attachment for use with external breast prosthesis, eachCarrier judgment$7.38–$8.131
J9217Leuprolide acetate (for depot suspension), 7.5 mgSpecial coverage instructions apply—1
J1952Leuprolide injectable, camcevi, 1 mgCarrier judgment—1
J3315Injection, triptorelin pamoate, 3.75 mgSpecial coverage instructions apply—1
J1954Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mgCarrier judgment—1
J9202Goserelin acetate implant, per 3.6 mgSpecial coverage instructions apply—1
J1950Injection, leuprolide acetate (for depot suspension), per 3.75 mgSpecial coverage instructions apply—1
J9219Leuprolide acetate implant, 65 mgSpecial coverage instructions apply—1
J9225Histrelin implant (vantas), 50 mgSpecial coverage instructions apply—1
Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgramSpecial coverage instructions apply—1
Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgramCarrier judgment—1
Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgramSpecial coverage instructions apply—1
J1442Injection, filgrastim (g-csf), excludes biosimilars, 1 microgramSpecial coverage instructions apply—1
J1449Injection, eflapegrastim-xnst, 0.1 mgCarrier judgment—1
J1447Injection, tbo-filgrastim, 1 microgramSpecial coverage instructions apply—1
Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mgCarrier judgment—1
Q5111Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mgCarrier judgment—1
Q5127Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mgCarrier judgment—1
J2506Injection, pegfilgrastim, excludes biosimilar, 0.5 mgCarrier judgment—1
Q5122Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mgCarrier judgment—1

5 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing D05.80

A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.

Other D05 diagnoses (Carcinoma in situ of breast)

Frequently asked questions

Does Medicare cover D05.80 (Other specified type of carcinoma in situ of unspecified…)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list D05.80 as a covered diagnosis for 30 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.

Which HCPCS codes can be billed with ICD-10 D05.80?

The Level II codes from the policies most specific to this diagnosis are L8035 (Custom breast prosthesis, post mastectomy, molded to…, 1 article); L8002 (Breast prosthesis, mastectomy bra, with integrated breast…, 1 article); L8001 (Breast prosthesis, mastectomy bra, with integrated breast…, 1 article); L8015 (External breast prosthesis garment, with mastectomy form…, 1 article); L8000 (Breast prosthesis, mastectomy bra, without integrated…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with D05.80?

Under the 2026 DMEPOS fee schedule (non-rural state fees): L8035 $4,403.11 to $5,283.69; L8002 $198.27 to $218.12; L8001 $150.77 to $165.83; L8015 $72.05 to $86.41. Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list D05.80?

A52478 (External Breast Prostheses - Policy Article); A59160 (Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs); A56748 (Billing and Coding: White Cell Colony Stimulating Factors).

What is ICD-10-CM code D05.80?

D05.80 is the ICD-10-CM code for other specified type of carcinoma in situ of unspecified breast, in category D05 (Carcinoma in situ of breast), chapter 2: Neoplasms.

Next steps

Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.

Chapter 2: Neoplasms · All diagnoses · HCPCS lookup