Is L8000 covered by Medicare?

Coverage varies by code, payer, and clinical context. Cross-check the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC), and any commercial payer policy for non-Medicare patients. Many HCPCS Level II codes (especially DME and certain drugs) require prior authorization.

What documentation is required for L8000?

Documentation must support medical necessity per the payer LCD or commercial-payer policy. For DME codes: written order, face-to-face encounter where required, beneficiary education. For drug codes: NDC, dose administered, units, route, site, wastage if applicable. For ambulance: origin, destination, miles, medical necessity. For supplies: linked diagnosis and medical necessity.

What are common denial reasons for L8000?

The most common denial categories are CO-16 (information missing or incorrect), CO-50 (medical necessity), and CO-151 (benefit maximum reached, often for DME rental cycles). Specific denial behavior varies by payer and plan.

Who can I get help from on L8000 billing?

For specialty-specific coding questions, AAPC- and AHIMA-credentialed coders on the Medonix team handle production billing for U.S. healthcare practices including HCPCS Level II claims (drugs, DME, ambulance, Medicare-specific procedures). Book a discovery call at /audit/ to talk through your specialty and payer mix.

HCPCS Level II · Orthotic and prosthetic procedures

L8000: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type

Name: Medonix MSO
Address: 300 Delaware Ave Suite 210, Wilmington, DE, 19801, US
Telephone: +1-302-520-5413
Price range: $$

L8000 is the HCPCS Level II code for Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type. Section L, Orthotic and prosthetic procedures. Code-specific billing context provided.

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L8000Mastectomy bra

Section: LCategory: Orthotic and prosthetic proceduresBillable

About this code

Mastectomy bra.

L8000 is a HCPCS Level II code in section L (Orthotic and prosthetic procedures). The full official descriptor is: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type.

Breast prosthesis garment, with mastectomy form, post-mastectomy. Document the post-mastectomy status and prescription. Some payers cover replacement on a defined cycle (typically every 6 to 24 months).

Payer-specific coverage rules vary. Always cross-check against the current Medicare Local Coverage Determination (LCD) for the adjudicating Medicare Administrative Contractor (MAC) or the commercial-payer policy.

Billing context

What practitioners watch for on L8000.

Code-specific billing guidance for L8000, written from production billing experience.

Documentation

Common denial categories

CO-16: Information missing or incorrect on the claim or supporting documentation. Add documentation specificity (NDC for drugs, serial number for DME, mileage for transport) and resubmit.
CO-50: Service not deemed medically necessary. Confirm the diagnosis-procedure relationship matches the payer LCD/NCD; attach clinical justification and resubmit.
CO-151: Payer benefit maximum reached for this period (often DME rental cycles). Verify benefit history; for DME rental-to-purchase cycles confirm month count and switch billing to purchase code where applicable.

Coverage signal

Post-mastectomy supplies are covered without cost-sharing under ACA preventive services for many commercial plans. Medicare covers under DME with specific frequency rules.

Common specialties

Oncology · Surgical Oncology · Family Medicine

Related codes

Other codes in section L.

Search all codes

Sources

Where this entry comes from.

NLM Clinical Tables Search Service: the official U.S. National Library of Medicine API for HCPCS Level II lookup.
CMS HCPCS Quarterly Update: the authoritative HCPCS Level II release with annual major updates each January.
CMS Medicare Coverage Database: Local Coverage Determinations and National Coverage Determinations for payer-specific rules.

Frequently asked

About HCPCS code L8000.

L8000 is the HCPCS Level II code for Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type. It belongs to section L (Orthotic and prosthetic procedures). Document the supply, drug, or service per the code descriptor and pair with the diagnosis (ICD-10) supporting medical necessity.

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