L8415 — Prosthetic sheath, upper limb, each
HCPCS Level II L-code · short descriptor: “Sheath upper limb”
- 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.
L8415 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $26.24 to $34.99 depending on state and rural status.
Former-CBA payment limits: ceiling $34.99 · floor $26.24
| State | Non-rural | Rural |
|---|---|---|
| AK | $30.04 | — |
| AL | $26.24 | — |
| AR | $28.64 | — |
| AZ | $29.31 | — |
| CA | $29.31 | — |
| CO | $28.98 | — |
| CT | $34.99 | — |
| DC | $27.93 | — |
| DE | $27.93 | — |
| FL | $26.24 | — |
| GA | $26.24 | — |
| HI | $32.14 | — |
| IA | $29.77 | — |
| ID | $33.23 | — |
| IL | $26.24 | — |
| IN | $26.24 | — |
| KS | $29.77 | — |
| KY | $26.24 | — |
| LA | $28.64 | — |
| MA | $34.99 | — |
| MD | $27.93 | — |
| ME | $34.99 | — |
| MI | $26.24 | — |
| MN | $26.24 | — |
| MO | $29.77 | — |
| MS | $26.24 | — |
| MT | $28.98 | — |
| NC | $26.24 | — |
| ND | $28.98 | — |
| NE | $29.77 | — |
| NH | $34.99 | — |
| NJ | $29.43 | — |
| NM | $28.64 | — |
| NV | $29.31 | — |
| NY | $29.43 | — |
| OH | $26.24 | — |
| OK | $28.64 | — |
| OR | $33.23 | — |
| PA | $27.93 | — |
| PR | $31.01 | — |
| RI | $34.99 | — |
| SC | $26.24 | — |
| SD | $28.98 | — |
| TN | $26.24 | — |
| TX | $28.64 | — |
| UT | $28.98 | — |
| VA | $27.93 | — |
| VI | $29.43 | — |
| VT | $34.99 | — |
| WA | $33.23 | — |
| WI | $26.24 | — |
| WV | $27.93 | — |
| WY | $28.98 | — |
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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