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HCPCS L8035 · Level II · orthotic and prosthetic code

L8035: Custom breast prosthesis, post mastectomy, molded to patient model, any type, HCPCS Level II orthotic and prosthetic code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for L8035

Medicare payment
$4,403.11 to $4,560.69
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
2
MAI 3
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

HCPCS Level II L8035 reads "Custom breast prosthesis, post mastectomy, molded to patient model, any type" in the October 2026 file; it dates from 1999. L8035 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $4,403.11 in CT, DC, DE and 11 more to $4,560.69 in CO, MT, ND and 3 more (floor $4,030.01, ceiling $5,373.34), October 2026. MUE limits for L8035: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration). 1 active LCD lists L8035: L33317 (External Breast Prostheses). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: L8030, L8045, L8020, L8015.

L8035 descriptor and code status

The October 2026 HCPCS Level II file describes L8035 as “Custom breast prosthesis, post mastectomy, molded to patient model, any type”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L8035
FieldValue
Short descriptorCustom breast prosth any
Added to HCPCS1999-01-01
Last actionC (long description changed), effective 2026-10-01
Coverage codeD: special coverage instructions apply
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L8035

L8035 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $4,403.11 in CT, DC, DE and 11 more to $4,560.69 in CO, MT, ND and 3 more (floor $4,030.01, ceiling $5,373.34), October 2026. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category PO (prosthetics and orthotics). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for L8035 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$4,030.01 / $5,373.34$4,403.11 (CT, DC, DE…) to $4,560.69 (CO, MT, ND…)—AK $4,403.12, HI $4,403.12, PR $5,283.69, VI $5,283.69

Hospital outpatient (OPPS Addendum B)

Status indicator A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for L8035

MUE limits for L8035: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration). The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for L8035 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital23 Date of Service Edit: ClinicalAnatomic Consideration
DME supplier23 Date of Service Edit: ClinicalAnatomic Consideration

The MUE lookup for L8035 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L8035 in v323r0.

L8035 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check L8035 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L8035

1 active Local Coverage Determination and 0 billing and coding articles list L8035. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on L8035

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L8035

CARC 151 · N362

units of L8035 exceed the DME supplier MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for L8035 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for L8035 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS L8035

What does HCPCS code L8035 describe?

"Custom breast prosthesis, post mastectomy, molded to patient model, any type" (short descriptor "Custom breast prosth any"), in the L section (orthotic and prosthetic procedures and devices). Added 1999-01-01; last action C (long description changed) effective 2026-10-01.

Is L8035 a CPT code?

No: CMS maintains L8035 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for L8035?

L8035 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $4,403.11 in CT, DC, DE and 11 more to $4,560.69 in CO, MT, ND and 3 more (floor $4,030.01, ceiling $5,373.34), October 2026.

How many units of L8035 can be billed per day?

MUE limits for L8035: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration). For the DME supplier MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L8035?

Coverage code D (special coverage instructions apply). 1 active LCD lists L8035: L33317 (External Breast Prostheses).

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.