L8041 — Midfacial prosthesis, provided by a non-physician
HCPCS Level II L-code · short descriptor: “Midfacial prosthesis”
- Code system
- HCPCS Level II
- Family
- L — Orthotics & prosthetics
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Prosthetics & orthotics
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 1
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-26; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-26; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
L8041 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $3390.11 to $4311.87 depending on state and rural status.
Former-CBA payment limits: ceiling $4378.51 · floor $3283.88
| State | Non-rural | Rural |
|---|---|---|
| AK | $4066.42 | — |
| AL | $3606.94 | — |
| AR | $3556.45 | — |
| AZ | $3794.81 | — |
| CA | $3794.81 | — |
| CO | $3465.95 | — |
| CT | $3877.12 | — |
| DC | $3692.26 | — |
| DE | $3692.26 | — |
| FL | $3606.94 | — |
| GA | $3606.94 | — |
| HI | $3893.35 | — |
| IA | $3390.11 | — |
| ID | $3622.02 | — |
| IL | $3679.20 | — |
| IN | $3679.20 | — |
| KS | $3390.11 | — |
| KY | $3606.94 | — |
| LA | $3556.45 | — |
| MA | $3877.12 | — |
| MD | $3692.26 | — |
| ME | $3877.12 | — |
| MI | $3679.20 | — |
| MN | $3679.20 | — |
| MO | $3390.11 | — |
| MS | $3606.94 | — |
| MT | $3465.95 | — |
| NC | $3606.94 | — |
| ND | $3465.95 | — |
| NE | $3390.11 | — |
| NH | $3877.12 | — |
| NJ | $4026.69 | — |
| NM | $3556.45 | — |
| NV | $3794.81 | — |
| NY | $4026.69 | — |
| OH | $3679.20 | — |
| OK | $3556.45 | — |
| OR | $3622.02 | — |
| PA | $3692.26 | — |
| PR | $3413.33 | — |
| RI | $3877.12 | — |
| SC | $3606.94 | — |
| SD | $3465.95 | — |
| TN | $3606.94 | — |
| TX | $3556.45 | — |
| UT | $3465.95 | — |
| VA | $3692.26 | — |
| VI | $4311.87 | — |
| VT | $3877.12 | — |
| WA | $3622.02 | — |
| WI | $3679.20 | — |
| WV | $3692.26 | — |
| WY | $3465.95 | — |
KM Prosthetics & orthotics
Medicare allowable ranges from $3220.58 to $4096.29 depending on state and rural status.
Former-CBA payment limits: ceiling $4159.57 · floor $3119.68
| State | Non-rural | Rural |
|---|---|---|
| AK | $3863.11 | — |
| AL | $3426.59 | — |
| AR | $3378.62 | — |
| AZ | $3605.07 | — |
| CA | $3605.07 | — |
| CO | $3292.65 | — |
| CT | $3683.28 | — |
| DC | $3507.63 | — |
| DE | $3507.63 | — |
| FL | $3426.59 | — |
| GA | $3426.59 | — |
| HI | $3698.63 | — |
| IA | $3220.58 | — |
| ID | $3440.86 | — |
| IL | $3495.19 | — |
| IN | $3495.19 | — |
| KS | $3220.58 | — |
| KY | $3426.59 | — |
| LA | $3378.62 | — |
| MA | $3683.28 | — |
| MD | $3507.63 | — |
| ME | $3683.28 | — |
| MI | $3495.19 | — |
| MN | $3495.19 | — |
| MO | $3220.58 | — |
| MS | $3426.59 | — |
| MT | $3292.65 | — |
| NC | $3426.59 | — |
| ND | $3292.65 | — |
| NE | $3220.58 | — |
| NH | $3683.28 | — |
| NJ | $3825.34 | — |
| NM | $3378.62 | — |
| NV | $3605.07 | — |
| NY | $3825.34 | — |
| OH | $3495.19 | — |
| OK | $3378.62 | — |
| OR | $3440.86 | — |
| PA | $3507.63 | — |
| PR | $3242.65 | — |
| RI | $3683.28 | — |
| SC | $3426.59 | — |
| SD | $3292.65 | — |
| TN | $3426.59 | — |
| TX | $3378.62 | — |
| UT | $3292.65 | — |
| VA | $3507.63 | — |
| VI | $4096.29 | — |
| VT | $3683.28 | — |
| WA | $3440.86 | — |
| WI | $3495.19 | — |
| WV | $3507.63 | — |
| WY | $3292.65 | — |
KN Prosthetics & orthotics
Medicare allowable ranges from $1356.04 to $1724.76 depending on state and rural status.
Former-CBA payment limits: ceiling $1751.41 · floor $1313.56
| State | Non-rural | Rural |
|---|---|---|
| AK | $1626.57 | — |
| AL | $1442.78 | — |
| AR | $1422.56 | — |
| AZ | $1517.97 | — |
| CA | $1517.97 | — |
| CO | $1386.36 | — |
| CT | $1550.86 | — |
| DC | $1476.93 | — |
| DE | $1476.93 | — |
| FL | $1442.78 | — |
| GA | $1442.78 | — |
| HI | $1557.32 | — |
| IA | $1356.04 | — |
| ID | $1448.81 | — |
| IL | $1471.71 | — |
| IN | $1471.71 | — |
| KS | $1356.04 | — |
| KY | $1442.78 | — |
| LA | $1422.56 | — |
| MA | $1550.86 | — |
| MD | $1476.93 | — |
| ME | $1550.86 | — |
| MI | $1471.71 | — |
| MN | $1471.71 | — |
| MO | $1356.04 | — |
| MS | $1442.78 | — |
| MT | $1386.36 | — |
| NC | $1442.78 | — |
| ND | $1386.36 | — |
| NE | $1356.04 | — |
| NH | $1550.86 | — |
| NJ | $1610.68 | — |
| NM | $1422.56 | — |
| NV | $1517.97 | — |
| NY | $1610.68 | — |
| OH | $1471.71 | — |
| OK | $1422.56 | — |
| OR | $1448.81 | — |
| PA | $1476.93 | — |
| PR | $1365.32 | — |
| RI | $1550.86 | — |
| SC | $1442.78 | — |
| SD | $1386.36 | — |
| TN | $1442.78 | — |
| TX | $1422.56 | — |
| UT | $1386.36 | — |
| VA | $1476.93 | — |
| VI | $1724.76 | — |
| VT | $1550.86 | — |
| WA | $1448.81 | — |
| WI | $1471.71 | — |
| WV | $1476.93 | — |
| WY | $1386.36 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L8041 at 1 unit per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.
Common denial codes to watch
Related L-codes
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