L8613 — Ossicula implant
HCPCS Level II L-code · short descriptor: “Ossicular implant”
- 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.
L8613 Medicare fee schedule (April 2026)
Base (no modifier) Prosthetics & orthotics
Medicare allowable ranges from $314.80 to $418.46 depending on state and rural status.
Former-CBA payment limits: ceiling $419.73 · floor $314.80
| State | Non-rural | Rural |
|---|---|---|
| AL | $370.27 | — |
| AR | $368.50 | — |
| AZ | $361.54 | — |
| CA | $361.54 | — |
| CO | $314.80 | — |
| CT | $382.50 | — |
| DC | $374.79 | — |
| DE | $374.79 | — |
| FL | $370.27 | — |
| GA | $370.27 | — |
| IA | $332.38 | — |
| ID | $368.50 | — |
| IL | $418.46 | — |
| IN | $418.46 | — |
| KS | $332.38 | — |
| KY | $370.27 | — |
| LA | $368.50 | — |
| MA | $382.50 | — |
| MD | $374.79 | — |
| ME | $382.50 | — |
| MI | $418.46 | — |
| MN | $418.46 | — |
| MO | $332.38 | — |
| MS | $370.27 | — |
| MT | $314.80 | — |
| NC | $370.27 | — |
| ND | $314.80 | — |
| NE | $332.38 | — |
| NH | $382.50 | — |
| NJ | $410.34 | — |
| NM | $368.50 | — |
| NV | $361.54 | — |
| NY | $410.34 | — |
| OH | $418.46 | — |
| OK | $368.50 | — |
| OR | $368.50 | — |
| PA | $374.79 | — |
| RI | $382.50 | — |
| SC | $370.27 | — |
| SD | $314.80 | — |
| TN | $370.27 | — |
| TX | $368.50 | — |
| UT | $314.80 | — |
| VA | $374.79 | — |
| VT | $382.50 | — |
| WA | $368.50 | — |
| WI | $418.46 | — |
| WV | $374.79 | — |
| WY | $314.80 | — |
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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