L8042 — Orbital prosthesis, provided by a non-physician
HCPCS Level II L-code · short descriptor: “Orbital 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
- 2
- 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.
L8042 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $3809.10 to $4844.80 depending on state and rural status.
Former-CBA payment limits: ceiling $4919.66 · floor $3689.75
| State | Non-rural | Rural |
|---|---|---|
| AK | $4569.01 | — |
| AL | $4052.70 | — |
| AR | $3996.01 | — |
| AZ | $4263.82 | — |
| CA | $4263.82 | — |
| CO | $3894.33 | — |
| CT | $4356.33 | — |
| DC | $4148.60 | — |
| DE | $4148.60 | — |
| FL | $4052.70 | — |
| GA | $4052.70 | — |
| HI | $4374.53 | — |
| IA | $3809.10 | — |
| ID | $4069.63 | — |
| IL | $4133.93 | — |
| IN | $4133.93 | — |
| KS | $3809.10 | — |
| KY | $4052.70 | — |
| LA | $3996.01 | — |
| MA | $4356.33 | — |
| MD | $4148.60 | — |
| ME | $4356.33 | — |
| MI | $4133.93 | — |
| MN | $4133.93 | — |
| MO | $3809.10 | — |
| MS | $4052.70 | — |
| MT | $3894.33 | — |
| NC | $4052.70 | — |
| ND | $3894.33 | — |
| NE | $3809.10 | — |
| NH | $4356.33 | — |
| NJ | $4524.39 | — |
| NM | $3996.01 | — |
| NV | $4263.82 | — |
| NY | $4524.39 | — |
| OH | $4133.93 | — |
| OK | $3996.01 | — |
| OR | $4069.63 | — |
| PA | $4148.60 | — |
| PR | $3835.15 | — |
| RI | $4356.33 | — |
| SC | $4052.70 | — |
| SD | $3894.33 | — |
| TN | $4052.70 | — |
| TX | $3996.01 | — |
| UT | $3894.33 | — |
| VA | $4148.60 | — |
| VI | $4844.80 | — |
| VT | $4356.33 | — |
| WA | $4069.63 | — |
| WI | $4133.93 | — |
| WV | $4148.60 | — |
| WY | $3894.33 | — |
KM Prosthetics & orthotics
Medicare allowable ranges from $3618.60 to $4602.58 depending on state and rural status.
Former-CBA payment limits: ceiling $4673.66 · floor $3505.25
| State | Non-rural | Rural |
|---|---|---|
| AK | $4340.59 | — |
| AL | $3850.07 | — |
| AR | $3796.17 | — |
| AZ | $4050.64 | — |
| CA | $4050.64 | — |
| CO | $3699.59 | — |
| CT | $4138.50 | — |
| DC | $3941.15 | — |
| DE | $3941.15 | — |
| FL | $3850.07 | — |
| GA | $3850.07 | — |
| HI | $4155.80 | — |
| IA | $3618.60 | — |
| ID | $3866.13 | — |
| IL | $3927.24 | — |
| IN | $3927.24 | — |
| KS | $3618.60 | — |
| KY | $3850.07 | — |
| LA | $3796.17 | — |
| MA | $4138.50 | — |
| MD | $3941.15 | — |
| ME | $4138.50 | — |
| MI | $3927.24 | — |
| MN | $3927.24 | — |
| MO | $3618.60 | — |
| MS | $3850.07 | — |
| MT | $3699.59 | — |
| NC | $3850.07 | — |
| ND | $3699.59 | — |
| NE | $3618.60 | — |
| NH | $4138.50 | — |
| NJ | $4298.14 | — |
| NM | $3796.17 | — |
| NV | $4050.64 | — |
| NY | $4298.14 | — |
| OH | $3927.24 | — |
| OK | $3796.17 | — |
| OR | $3866.13 | — |
| PA | $3941.15 | — |
| PR | $3643.45 | — |
| RI | $4138.50 | — |
| SC | $3850.07 | — |
| SD | $3699.59 | — |
| TN | $3850.07 | — |
| TX | $3796.17 | — |
| UT | $3699.59 | — |
| VA | $3941.15 | — |
| VI | $4602.58 | — |
| VT | $4138.50 | — |
| WA | $3866.13 | — |
| WI | $3927.24 | — |
| WV | $3941.15 | — |
| WY | $3699.59 | — |
KN Prosthetics & orthotics
Medicare allowable ranges from $1523.65 to $1937.90 depending on state and rural status.
Former-CBA payment limits: ceiling $1967.87 · floor $1475.90
| State | Non-rural | Rural |
|---|---|---|
| AK | $1827.59 | — |
| AL | $1621.08 | — |
| AR | $1598.41 | — |
| AZ | $1705.54 | — |
| CA | $1705.54 | — |
| CO | $1557.72 | — |
| CT | $1742.54 | — |
| DC | $1659.45 | — |
| DE | $1659.45 | — |
| FL | $1621.08 | — |
| GA | $1621.08 | — |
| HI | $1749.80 | — |
| IA | $1523.65 | — |
| ID | $1627.86 | — |
| IL | $1653.59 | — |
| IN | $1653.59 | — |
| KS | $1523.65 | — |
| KY | $1621.08 | — |
| LA | $1598.41 | — |
| MA | $1742.54 | — |
| MD | $1659.45 | — |
| ME | $1742.54 | — |
| MI | $1653.59 | — |
| MN | $1653.59 | — |
| MO | $1523.65 | — |
| MS | $1621.08 | — |
| MT | $1557.72 | — |
| NC | $1621.08 | — |
| ND | $1557.72 | — |
| NE | $1523.65 | — |
| NH | $1742.54 | — |
| NJ | $1809.75 | — |
| NM | $1598.41 | — |
| NV | $1705.54 | — |
| NY | $1809.75 | — |
| OH | $1653.59 | — |
| OK | $1598.41 | — |
| OR | $1627.86 | — |
| PA | $1659.45 | — |
| PR | $1534.04 | — |
| RI | $1742.54 | — |
| SC | $1621.08 | — |
| SD | $1557.72 | — |
| TN | $1621.08 | — |
| TX | $1598.41 | — |
| UT | $1557.72 | — |
| VA | $1659.45 | — |
| VI | $1937.90 | — |
| VT | $1742.54 | — |
| WA | $1627.86 | — |
| WI | $1653.59 | — |
| WV | $1659.45 | — |
| WY | $1557.72 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L8042 at 2 units 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
Bill L8042 with confidence
Track prior-authorization requests with AI pre-fill and deadline tracking, and draft PA appeal letters — built for DME teams, PHI-free: no patient data is collected or stored.
Start free trial Run a CMS-0057-F readiness checkPrefer DIY compliance? Self-audit documentation kits for DME suppliers →
Building an AI agent? Try the agent API in the playground — free PA-required lookups, L8042 included, and starter credits via POST /bot-marketplace/register.