L8043 — Upper facial prosthesis, provided by a non-physician
HCPCS Level II L-code · short descriptor: “Upper facial 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
- 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.
L8043 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $4266.20 to $5426.13 depending on state and rural status.
Former-CBA payment limits: ceiling $5510.04 · floor $4132.53
| State | Non-rural | Rural |
|---|---|---|
| AK | $5117.31 | — |
| AL | $4539.05 | — |
| AR | $4475.52 | — |
| AZ | $4775.50 | — |
| CA | $4775.50 | — |
| CO | $4361.65 | — |
| CT | $4879.09 | — |
| DC | $4646.49 | — |
| DE | $4646.49 | — |
| FL | $4539.05 | — |
| GA | $4539.05 | — |
| HI | $4899.45 | — |
| IA | $4266.20 | — |
| ID | $4557.98 | — |
| IL | $4630.01 | — |
| IN | $4630.01 | — |
| KS | $4266.20 | — |
| KY | $4539.05 | — |
| LA | $4475.52 | — |
| MA | $4879.09 | — |
| MD | $4646.49 | — |
| ME | $4879.09 | — |
| MI | $4630.01 | — |
| MN | $4630.01 | — |
| MO | $4266.20 | — |
| MS | $4539.05 | — |
| MT | $4361.65 | — |
| NC | $4539.05 | — |
| ND | $4361.65 | — |
| NE | $4266.20 | — |
| NH | $4879.09 | — |
| NJ | $5067.31 | — |
| NM | $4475.52 | — |
| NV | $4775.50 | — |
| NY | $5067.31 | — |
| OH | $4630.01 | — |
| OK | $4475.52 | — |
| OR | $4557.98 | — |
| PA | $4646.49 | — |
| PR | $4295.38 | — |
| RI | $4879.09 | — |
| SC | $4539.05 | — |
| SD | $4361.65 | — |
| TN | $4539.05 | — |
| TX | $4475.52 | — |
| UT | $4361.65 | — |
| VA | $4646.49 | — |
| VI | $5426.13 | — |
| VT | $4879.09 | — |
| WA | $4557.98 | — |
| WI | $4630.01 | — |
| WV | $4646.49 | — |
| WY | $4361.65 | — |
KM Prosthetics & orthotics
Medicare allowable ranges from $4052.87 to $5154.84 depending on state and rural status.
Former-CBA payment limits: ceiling $5234.53 · floor $3925.90
| State | Non-rural | Rural |
|---|---|---|
| AK | $4861.43 | — |
| AL | $4312.05 | — |
| AR | $4251.77 | — |
| AZ | $4536.69 | — |
| CA | $4536.69 | — |
| CO | $4143.54 | — |
| CT | $4635.15 | — |
| DC | $4414.16 | — |
| DE | $4414.16 | — |
| FL | $4312.05 | — |
| GA | $4312.05 | — |
| HI | $4654.46 | — |
| IA | $4052.87 | — |
| ID | $4330.09 | — |
| IL | $4398.54 | — |
| IN | $4398.54 | — |
| KS | $4052.87 | — |
| KY | $4312.05 | — |
| LA | $4251.77 | — |
| MA | $4635.15 | — |
| MD | $4414.16 | — |
| ME | $4635.15 | — |
| MI | $4398.54 | — |
| MN | $4398.54 | — |
| MO | $4052.87 | — |
| MS | $4312.05 | — |
| MT | $4143.54 | — |
| NC | $4312.05 | — |
| ND | $4143.54 | — |
| NE | $4052.87 | — |
| NH | $4635.15 | — |
| NJ | $4813.90 | — |
| NM | $4251.77 | — |
| NV | $4536.69 | — |
| NY | $4813.90 | — |
| OH | $4398.54 | — |
| OK | $4251.77 | — |
| OR | $4330.09 | — |
| PA | $4414.16 | — |
| PR | $4080.61 | — |
| RI | $4635.15 | — |
| SC | $4312.05 | — |
| SD | $4143.54 | — |
| TN | $4312.05 | — |
| TX | $4251.77 | — |
| UT | $4143.54 | — |
| VA | $4414.16 | — |
| VI | $5154.84 | — |
| VT | $4635.15 | — |
| WA | $4330.09 | — |
| WI | $4398.54 | — |
| WV | $4414.16 | — |
| WY | $4143.54 | — |
KN Prosthetics & orthotics
Medicare allowable ranges from $1706.46 to $2170.48 depending on state and rural status.
Former-CBA payment limits: ceiling $2204.00 · floor $1653.00
| State | Non-rural | Rural |
|---|---|---|
| AK | $2046.90 | — |
| AL | $1815.60 | — |
| AR | $1790.23 | — |
| AZ | $1910.16 | — |
| CA | $1910.16 | — |
| CO | $1744.62 | — |
| CT | $1951.61 | — |
| DC | $1858.57 | — |
| DE | $1858.57 | — |
| FL | $1815.60 | — |
| GA | $1815.60 | — |
| HI | $1959.80 | — |
| IA | $1706.46 | — |
| ID | $1823.20 | — |
| IL | $1852.02 | — |
| IN | $1852.02 | — |
| KS | $1706.46 | — |
| KY | $1815.60 | — |
| LA | $1790.23 | — |
| MA | $1951.61 | — |
| MD | $1858.57 | — |
| ME | $1951.61 | — |
| MI | $1852.02 | — |
| MN | $1852.02 | — |
| MO | $1706.46 | — |
| MS | $1815.60 | — |
| MT | $1744.62 | — |
| NC | $1815.60 | — |
| ND | $1744.62 | — |
| NE | $1706.46 | — |
| NH | $1951.61 | — |
| NJ | $2026.95 | — |
| NM | $1790.23 | — |
| NV | $1910.16 | — |
| NY | $2026.95 | — |
| OH | $1852.02 | — |
| OK | $1790.23 | — |
| OR | $1823.20 | — |
| PA | $1858.57 | — |
| PR | $1718.16 | — |
| RI | $1951.61 | — |
| SC | $1815.60 | — |
| SD | $1744.62 | — |
| TN | $1815.60 | — |
| TX | $1790.23 | — |
| UT | $1744.62 | — |
| VA | $1858.57 | — |
| VI | $2170.48 | — |
| VT | $1951.61 | — |
| WA | $1823.20 | — |
| WI | $1852.02 | — |
| WV | $1858.57 | — |
| WY | $1744.62 | — |
Common denial codes to watch
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