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HCPCS L8039 · Level II · orthotic and prosthetic code

L8039: Breast prosthesis, not otherwise specified, 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); 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 NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for L8039

Medicare payment
paid outside OPPS
OPPS SI A: another fee schedule or payment system
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
0
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

CMS describes HCPCS L8039, added in 1998, as "Breast prosthesis, not otherwise specified". None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L8039; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L8039 under a fee schedule or payment system other than OPPS. CMS caps L8039 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. 1 active LCD lists L8039: L33317 (External Breast Prostheses). HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 46; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 6 other active codes open with "Breast prosthesis"; related codes: L8030, L8020, L8002, L8001.

L8039 descriptor and code status

The October 2026 HCPCS Level II file describes L8039 as “Breast prosthesis, not otherwise specified”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L8039
FieldValue
Short descriptorBreast prosthesis nos
Added to HCPCS1998-01-01
Last actionN (no maintenance), effective 1998-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator46: DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L8039

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L8039; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L8039 under a fee schedule or payment system other than OPPS. 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.

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 L8039

CMS caps L8039 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for L8039 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 L8039 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L8039 in v323r0.

L8039 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 L8039 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L8039

1 active Local Coverage Determination and 0 billing and coding articles list L8039. 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 L8039

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists L8039

CARC 151 · N362

units of L8039 exceed the practitioner MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for L8039 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for L8039 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS L8039

What does HCPCS code L8039 describe?

"Breast prosthesis, not otherwise specified" (short descriptor "Breast prosthesis nos"), in the L section (orthotic and prosthetic procedures and devices). Added 1998-01-01.

Is L8039 a CPT code?

It is not. L8039 belongs to the L section (orthotic and prosthetic procedures and devices) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for L8039?

None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L8039; its HCPCS pricing indicator is 46 (DMEPOS contractor-priced (not otherwise classified, individual determination or gap-filled)). Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays L8039 under a fee schedule or payment system other than OPPS.

How many units of L8039 can be billed per day?

CMS caps L8039 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Anatomic Consideration); DME supplier 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L8039?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD lists L8039: L33317 (External Breast Prostheses).

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.