L8046 — Partial facial prosthesis, provided by a non-physician
HCPCS Level II L-code · short descriptor: “Partial 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
- 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 2026-10-25; 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 2026-10-25; 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.
L8046 Medicare fee schedule (October 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $3047.25 to $3875.84 depending on state and rural status.
Former-CBA payment limits: ceiling $3935.73 · floor $2951.79
| State | Non-rural | Rural |
|---|---|---|
| AK | $3655.23 | — |
| AL | $3242.18 | — |
| AR | $3196.79 | — |
| AZ | $3411.08 | — |
| CA | $3411.08 | — |
| CO | $3115.45 | — |
| CT | $3485.04 | — |
| DC | $3318.85 | — |
| DE | $3318.85 | — |
| FL | $3242.18 | — |
| GA | $3242.18 | — |
| HI | $3499.64 | — |
| IA | $3047.25 | — |
| ID | $3255.69 | — |
| IL | $3307.18 | — |
| IN | $3307.18 | — |
| KS | $3047.25 | — |
| KY | $3242.18 | — |
| LA | $3196.79 | — |
| MA | $3485.04 | — |
| MD | $3318.85 | — |
| ME | $3485.04 | — |
| MI | $3307.18 | — |
| MN | $3307.18 | — |
| MO | $3047.25 | — |
| MS | $3242.18 | — |
| MT | $3115.45 | — |
| NC | $3242.18 | — |
| ND | $3115.45 | — |
| NE | $3047.25 | — |
| NH | $3485.04 | — |
| NJ | $3619.49 | — |
| NM | $3196.79 | — |
| NV | $3411.08 | — |
| NY | $3619.49 | — |
| OH | $3307.18 | — |
| OK | $3196.79 | — |
| OR | $3255.69 | — |
| PA | $3318.85 | — |
| PR | $3068.13 | — |
| RI | $3485.04 | — |
| SC | $3242.18 | — |
| SD | $3115.45 | — |
| TN | $3242.18 | — |
| TX | $3196.79 | — |
| UT | $3115.45 | — |
| VA | $3318.85 | — |
| VI | $3875.84 | — |
| VT | $3485.04 | — |
| WA | $3255.69 | — |
| WI | $3307.18 | — |
| WV | $3318.85 | — |
| WY | $3115.45 | — |
KM Prosthetics & orthotics
Medicare allowable ranges from $2894.89 to $3682.03 depending on state and rural status.
Former-CBA payment limits: ceiling $3738.95 · floor $2804.21
| State | Non-rural | Rural |
|---|---|---|
| AK | $3472.47 | — |
| AL | $3080.06 | — |
| AR | $3036.94 | — |
| AZ | $3240.50 | — |
| CA | $3240.50 | — |
| CO | $2959.70 | — |
| CT | $3310.82 | — |
| DC | $3152.94 | — |
| DE | $3152.94 | — |
| FL | $3080.06 | — |
| GA | $3080.06 | — |
| HI | $3324.65 | — |
| IA | $2894.89 | — |
| ID | $3092.92 | — |
| IL | $3141.80 | — |
| IN | $3141.80 | — |
| KS | $2894.89 | — |
| KY | $3080.06 | — |
| LA | $3036.94 | — |
| MA | $3310.82 | — |
| MD | $3152.94 | — |
| ME | $3310.82 | — |
| MI | $3141.80 | — |
| MN | $3141.80 | — |
| MO | $2894.89 | — |
| MS | $3080.06 | — |
| MT | $2959.70 | — |
| NC | $3080.06 | — |
| ND | $2959.70 | — |
| NE | $2894.89 | — |
| NH | $3310.82 | — |
| NJ | $3438.55 | — |
| NM | $3036.94 | — |
| NV | $3240.50 | — |
| NY | $3438.55 | — |
| OH | $3141.80 | — |
| OK | $3036.94 | — |
| OR | $3092.92 | — |
| PA | $3152.94 | — |
| PR | $2914.72 | — |
| RI | $3310.82 | — |
| SC | $3080.06 | — |
| SD | $2959.70 | — |
| TN | $3080.06 | — |
| TX | $3036.94 | — |
| UT | $2959.70 | — |
| VA | $3152.94 | — |
| VI | $3682.03 | — |
| VT | $3310.82 | — |
| WA | $3092.92 | — |
| WI | $3141.80 | — |
| WV | $3152.94 | — |
| WY | $2959.70 | — |
KN Prosthetics & orthotics
Medicare allowable ranges from $1218.90 to $1550.34 depending on state and rural status.
Former-CBA payment limits: ceiling $1574.28 · floor $1180.71
| State | Non-rural | Rural |
|---|---|---|
| AK | $1462.10 | — |
| AL | $1296.84 | — |
| AR | $1278.71 | — |
| AZ | $1364.39 | — |
| CA | $1364.39 | — |
| CO | $1246.15 | — |
| CT | $1394.05 | — |
| DC | $1327.53 | — |
| DE | $1327.53 | — |
| FL | $1296.84 | — |
| GA | $1296.84 | — |
| HI | $1399.85 | — |
| IA | $1218.90 | — |
| ID | $1302.23 | — |
| IL | $1322.89 | — |
| IN | $1322.89 | — |
| KS | $1218.90 | — |
| KY | $1296.84 | — |
| LA | $1278.71 | — |
| MA | $1394.05 | — |
| MD | $1327.53 | — |
| ME | $1394.05 | — |
| MI | $1322.89 | — |
| MN | $1322.89 | — |
| MO | $1218.90 | — |
| MS | $1296.84 | — |
| MT | $1246.15 | — |
| NC | $1296.84 | — |
| ND | $1246.15 | — |
| NE | $1218.90 | — |
| NH | $1394.05 | — |
| NJ | $1447.81 | — |
| NM | $1278.71 | — |
| NV | $1364.39 | — |
| NY | $1447.81 | — |
| OH | $1322.89 | — |
| OK | $1278.71 | — |
| OR | $1302.23 | — |
| PA | $1327.53 | — |
| PR | $1227.26 | — |
| RI | $1394.05 | — |
| SC | $1296.84 | — |
| SD | $1246.15 | — |
| TN | $1296.84 | — |
| TX | $1278.71 | — |
| UT | $1246.15 | — |
| VA | $1327.53 | — |
| VI | $1550.34 | — |
| VT | $1394.05 | — |
| WA | $1302.23 | — |
| WI | $1322.89 | — |
| WV | $1327.53 | — |
| WY | $1246.15 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps L8046 at 1 unit per date of service (clinical). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.
Common denial codes to watch
Related L-codes
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