Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

L8000 - L8039  Prosthetic Procedures - Breast Prostheses

L8000
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
shortMastectomy bra
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH6.03 Date of Service Edit: ClinicalClinical: Data
DME6.03 Date of Service Edit: ClinicalClinical: Data
L8001
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
shortBreast prosthesis bra & form
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH4.03 Date of Service Edit: ClinicalClinical: Data
DME4.03 Date of Service Edit: ClinicalClinical: Data
L8002
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
shortBrst prsth bra & bilat form
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH4.03 Date of Service Edit: ClinicalClinical: Data
DME4.03 Date of Service Edit: ClinicalClinical: Data
L8010
Breast prosthesis, mastectomy sleeve
shortMastectomy sleeve
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH4.03 Date of Service Edit: ClinicalClinical: Data
DME0.03 Date of Service Edit: ClinicalPublished Contractor Policy
L8015
External breast prosthesis garment, with mastectomy form, post mastectomy
shortExt breastprosthesis garment
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH4.03 Date of Service Edit: ClinicalClinical: Data
DME4.03 Date of Service Edit: ClinicalClinical: Data
L8020
Breast prosthesis, mastectomy form
shortMastectomy form
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH4.03 Date of Service Edit: ClinicalClinical: Data
DME4.03 Date of Service Edit: ClinicalClinical: Data
L8030
Breast prosthesis, silicone or equal, without integral adhesive
shortBreast prosthes w/o adhesive
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalAnatomic Consideration
DME2.03 Date of Service Edit: ClinicalAnatomic Consideration
L8031
Breast prosthesis, silicone or equal, with integral adhesive
shortBreast prosthesis w adhesive
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalAnatomic Consideration
DME2.03 Date of Service Edit: ClinicalAnatomic Consideration
L8032
Nipple prosthesis, prefabricated, reusable, any type, each
shortReusable nipple prosthesis
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.02 Date of Service Edit: PolicyAnatomic Consideration
DME2.02 Date of Service Edit: PolicyAnatomic Consideration
L8033
Nipple prosthesis, custom fabricated, reusable, any material, any type, each
shortNipple prosthesis custom, ea
L8035
Custom breast prosthesis, post mastectomy, molded to patient model
shortCustom breast prosthesis
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalAnatomic Consideration
DME2.03 Date of Service Edit: ClinicalAnatomic Consideration
L8039
Breast prosthesis, not otherwise specified
shortBreast prosthesis nos
MUE
LocationValueAjudication IndicatorRationale
PRA0.03 Date of Service Edit: ClinicalCMS Policy
OPH2.03 Date of Service Edit: ClinicalAnatomic Consideration
DME2.03 Date of Service Edit: ClinicalAnatomic Consideration