L8001 — Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
HCPCS Level II L-code · short descriptor: “Breast prosthesis bra & form”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Status
- Active (April 2026 HCPCS)
Prior authorization
Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
L8001 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $150.77 to $165.83 depending on state and rural status.
Former-CBA payment limits: ceiling $183.98 · floor $137.98
| State | Non-rural | Rural |
|---|---|---|
| AK | $150.77 | — |
| AL | $155.28 | — |
| AR | $155.27 | — |
| AZ | $150.77 | — |
| CA | $150.77 | — |
| CO | $156.14 | — |
| CT | $150.77 | — |
| DC | $150.77 | — |
| DE | $150.77 | — |
| FL | $155.28 | — |
| GA | $155.28 | — |
| HI | $150.77 | — |
| IA | $153.68 | — |
| ID | $150.77 | — |
| IL | $154.49 | — |
| IN | $154.49 | — |
| KS | $153.68 | — |
| KY | $155.28 | — |
| LA | $155.27 | — |
| MA | $150.77 | — |
| MD | $150.77 | — |
| ME | $150.77 | — |
| MI | $154.49 | — |
| MN | $154.49 | — |
| MO | $153.68 | — |
| MS | $155.28 | — |
| MT | $156.14 | — |
| NC | $155.28 | — |
| ND | $156.14 | — |
| NE | $153.68 | — |
| NH | $150.77 | — |
| NJ | $150.77 | — |
| NM | $155.27 | — |
| NV | $150.77 | — |
| NY | $150.77 | — |
| OH | $154.49 | — |
| OK | $155.27 | — |
| OR | $150.77 | — |
| PA | $150.77 | — |
| PR | $165.83 | — |
| RI | $150.77 | — |
| SC | $155.28 | — |
| SD | $156.14 | — |
| TN | $155.28 | — |
| TX | $155.27 | — |
| UT | $156.14 | — |
| VA | $150.77 | — |
| VI | $165.83 | — |
| VT | $150.77 | — |
| WA | $150.77 | — |
| WI | $154.49 | — |
| WV | $150.77 | — |
| WY | $156.14 | — |
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026.
Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%.
A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area
adjustments and non-continental rates can differ — verify with your DME MAC.
Common denial codes to watch
Related L-codes
Bill L8001 with confidence
MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →