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HCPCS L8604 · Level II · orthotic and prosthetic code

L8604: Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 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). Next CMS release: January 1, 2027 (quarterly update).

Key facts for L8604

Medicare payment
not separately priced
HCPCS pricing indicator 00 (Part B)
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
3
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II L8604 reads "Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies" in the October 2026 file; it dates from 2009. Part B does not price L8604 separately: the HCPCS file gives it pricing indicator 00. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L8604. CMS caps L8604 at practitioner 3 (MAI 3, Clinical: Data); hospital outpatient 3 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists L8604; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 00; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 3 other active codes open with "Injectable bulking agent"; related codes: L8606, L8603, L8605, L8607.

L8604 descriptor and code status

The October 2026 HCPCS Level II file describes L8604 as “Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes.

HCPCS file attributes of L8604
FieldValue
Short descriptorDextranomer/hyaluronic acid
Added to HCPCS2009-01-01
Last actionN (no maintenance), effective 2009-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator00: not separately priced by Part B
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for L8604

Part B does not price L8604 separately: the HCPCS file gives it pricing indicator 00. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L8604. 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 N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for L8604

CMS caps L8604 at practitioner 3 (MAI 3, Clinical: Data); hospital outpatient 3 (MAI 3, Clinical: Data) 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 L8604 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services33 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital33 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for L8604 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L8604 in v323r0.

L8604 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 L8604 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L8604

No current LCD or billing and coding article lists L8604. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on L8604

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of L8604 exceed the practitioner MUE of 3 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 L8604 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for L8604 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 L8604

What does HCPCS code L8604 describe?

"Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, urinary tract, 1 ml, includes shipping and necessary supplies" (short descriptor "Dextranomer/hyaluronic acid"), in the L section (orthotic and prosthetic procedures and devices). Added 2009-01-01.

Is L8604 a CPT code?

It is not. L8604 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 L8604?

Part B does not price L8604 separately: the HCPCS file gives it pricing indicator 00. None of the October 2026 PFS, DMEPOS, CLFS, OPPS or ASC files lists a national amount for L8604.

How many units of L8604 can be billed per day?

CMS caps L8604 at practitioner 3 (MAI 3, Clinical: Data); hospital outpatient 3 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 3 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover L8604?

No current LCD or billing article lists L8604; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

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.