HCPCS Code L8000: Breast Prosthesis, Mastectomy Bra, Without Integrated Breast Prosthesis Form, Any Size, Any Type

HCPCS Code L8000 covers mastectomy bras without integrated prostheses, used post mastectomy for external breast prosthesis billing and coverage.

Use Code

## **What is HCPCS Code L8000?** HCPCS Code L8000 is defined as a “Mastectomy bra, any type, each.” This code applies only to the mastectomy bra itself and does not include an external breast prosthesis. The bra is designed to hold a removable breast prosthesis adjacent to the chest wall, providing comfort and support after a mastectomy. If a bra contains a built-in prosthetic form, it is not billed under L8000, since prostheses are reported separately with codes such as L8030 or L8031. This code is part of the Breast Prosthetics and Accessories category and is used primarily for billing and insurance claims related to mastectomy bras for patients who have undergone breast surgery. It ensures consistent claims processing for durable medical equipment (DME) suppliers and healthcare providers furnishing post-mastectomy care. The code is maintained by CMS and is standardized for use to support orderly reimbursement by Medicare and other health insurers. Providers must submit proper documentation and a physician’s order confirming the patient’s mastectomy and need for a mastectomy bra to establish medical necessity. Coverage policies and replacement limits may vary by Medicare Administrative Contractor (MAC) and other payers, so adherence to local coverage determinations is essential.

## **HCPCS Code L8000 documentation requirements** A Standard Written Order (SWO) is required prior to claim submission. The SWO must include the beneficiary’s name, a description of the item (e.g., mastectomy bra), the treating practitioner’s name/NPI/signature, and the date of the order. Medical records must support medical necessity, documenting that the patient has had a mastectomy and requires a mastectomy bra to hold an external breast prosthesis. Documentation should clearly state the mastectomy history or absence of a breast, as this is the qualifying condition for coverage. Proof of delivery is required, showing the beneficiary’s name, delivery address, detailed description of the bra, delivery date, and the beneficiary or designee’s signature.

## **HCPCS Code L8000 billing requirements** Medicare does not impose a fixed numerical limit or replacement cycle for mastectomy bras. Instead, coverage is based on medical necessity, documented in the patient’s medical record and supported by a valid order from the treating practitioner. Claims must report the correct HCPCS code (L8000) and include an appropriate ICD-10 diagnosis code, such as a history of mastectomy, to establish eligibility. The NU modifier must be used to indicate that the item was purchased new, as consistent with Medicare claims guidance. RT and LT modifiers are not generally required because mastectomy bras are considered inherently bilateral, though some MACs may accept them if reported. For non-covered items or when a valid order is missing, modifiers such as GA (waiver of liability), GY (not covered by Medicare), or GZ (expected denial) may be applied in accordance with Medicare rules. All billing must follow CMS coverage policies and any MAC-specific requirements, and suppliers must keep complete documentation to demonstrate medical necessity, support reimbursement, and withstand audits.

## **Other relevant codes** - L8001: Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type - L8002:Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type - L8015: External breast prosthesis garment, with mastectomy form, post-mastectomy - L8020: Breast prosthesis mastectomy form - L8030: Breast prosthesis, silicone or equal, without integral adhesive

Frequently asked questions

HCPCS Code L8000 is for a breast prosthesis, specifically a mastectomy bra without integrated breast prosthesis form, any size, any type.

Medicare covers two mastectomy bras (L8000) every seven months.

There isn't a specific CPT code for breast prosthesis; breast prostheses are generally coded using HCPCS codes such as L8000-L8039.

Common CPT codes for breast drainage include codes like 10021 (fine needle aspiration) or 19000 (breast aspiration); however, precise coding depends on the procedure type and clinical context (not specifically HCPCS) [general CPT coding knowledge].