L8030 — Breast prosthesis, silicone or equal, without integral adhesive
HCPCS Level II L-code · short descriptor: “Breast prosthes w/o adhesive”
- 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.
L8030 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $386.23 to $514.97 depending on state and rural status.
Former-CBA payment limits: ceiling $514.97 · floor $386.23
| State | Non-rural | Rural |
|---|---|---|
| AK | $475.07 | — |
| AL | $403.72 | — |
| AR | $408.38 | — |
| AZ | $467.55 | — |
| CA | $467.55 | — |
| CO | $435.83 | — |
| CT | $514.97 | — |
| DC | $396.42 | — |
| DE | $396.42 | — |
| FL | $403.72 | — |
| GA | $403.72 | — |
| HI | $508.01 | — |
| IA | $436.55 | — |
| ID | $386.23 | — |
| IL | $430.39 | — |
| IN | $430.39 | — |
| KS | $436.55 | — |
| KY | $403.72 | — |
| LA | $408.38 | — |
| MA | $514.97 | — |
| MD | $396.42 | — |
| ME | $514.97 | — |
| MI | $430.39 | — |
| MN | $430.39 | — |
| MO | $436.55 | — |
| MS | $403.72 | — |
| MT | $435.83 | — |
| NC | $403.72 | — |
| ND | $435.83 | — |
| NE | $436.55 | — |
| NH | $514.97 | — |
| NJ | $395.95 | — |
| NM | $408.38 | — |
| NV | $467.55 | — |
| NY | $395.95 | — |
| OH | $430.39 | — |
| OK | $408.38 | — |
| OR | $386.23 | — |
| PA | $396.42 | — |
| PR | $413.48 | — |
| RI | $514.97 | — |
| SC | $403.72 | — |
| SD | $435.83 | — |
| TN | $403.72 | — |
| TX | $408.38 | — |
| UT | $435.83 | — |
| VA | $396.42 | — |
| VI | $395.95 | — |
| VT | $514.97 | — |
| WA | $386.23 | — |
| WI | $430.39 | — |
| WV | $396.42 | — |
| WY | $435.83 | — |
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
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