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HCPCS L8612 · Level II · orthotic and prosthetic code

L8612: Aqueous shunt, 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). Next CMS release: January 1, 2027 (quarterly update).

Key facts for L8612

Medicare payment
$744.39 to $974.58
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
0
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

L8612 is a Level II code from the L section (orthotic and prosthetic procedures and devices), in use since 1992: "Aqueous shunt". L8612 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $744.39 in IA, KS, MO and 1 more to $974.58 in IL, IN, MI and 3 more (floor $744.39, ceiling $992.51), October 2026. MUE limits for L8612: practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data); DME supplier 0 (MAI 3, CMS Policy). L8612 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: L8610, L8614, L8607, L8606.

L8612 descriptor and code status

The October 2026 HCPCS Level II file describes L8612 as “Aqueous shunt”. It sits in the L section (orthotic and prosthetic procedures and devices), listed with the other L codes. Although searches often call it the "L8612 CPT code", L8612 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of L8612
FieldValue
Short descriptorAqueous shunt prosthesis
Added to HCPCS1992-01-01
Last actionN (no maintenance), effective 1997-10-01
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
Cross-referenceQ0074

Medicare payment for L8612

L8612 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $744.39 in IA, KS, MO and 1 more to $974.58 in IL, IN, MI and 3 more (floor $744.39, ceiling $992.51), 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 L (local Part B 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 L8612 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$744.39 / $992.51$744.39 (IA, KS, MO…) to $974.58 (IL, IN, MI…)——

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 L8612

MUE limits for L8612: practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data); DME supplier 0 (MAI 3, CMS Policy). 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 L8612 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital13 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for L8612 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists L8612 in v323r0.

L8612 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 L8612 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for L8612

No current LCD or billing and coding article lists L8612. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on L8612

CARC 50 · N115

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

CARC 151 · N362

units of L8612 exceed the DME supplier MUE of 0 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 L8612 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for L8612 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 L8612

What does HCPCS code L8612 describe?

"Aqueous shunt" (short descriptor "Aqueous shunt prosthesis"), in the L section (orthotic and prosthetic procedures and devices). Added 1992-01-01; last action N (no maintenance) effective 1997-10-01.

Is L8612 a CPT code?

No: CMS maintains L8612 in HCPCS Level II, while the AMA maintains CPT. People do search "L8612 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for L8612?

L8612 is paid from the DMEPOS fee schedule as prosthetics and orthotics (PO): $744.39 in IA, KS, MO and 1 more to $974.58 in IL, IN, MI and 3 more (floor $744.39, ceiling $992.51), October 2026.

How many units of L8612 can be billed per day?

MUE limits for L8612: practitioner 1 (MAI 3, Clinical: Data); hospital outpatient 1 (MAI 3, Clinical: Data); DME supplier 0 (MAI 3, CMS Policy). For the DME supplier 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 L8612?

L8612 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

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.