L8030 — Breast prosthesis, silicone or equal, without integral adhesive
L8030 is a HCPCS Level II code for breast prosthesis, silicone or equal, without integral adhesive. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of L8030 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 2 units MAI 3 — Date of Service Edit: Clinical · Anatomic Consideration
- DME supplier
- 2 units MAI 3 — Date of Service Edit: Clinical · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for L8030
- Long descriptor
- Breast prosthesis, silicone or equal, without integral adhesive
- Short descriptor
- Breast prosthes w/o adhesive
- Added
- January 1, 1989
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to L8030
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L8030 is not quite right, the correct code is very often within a few positions of it.
- L7900Male vacuum erection system
- L7902Tension ring, for vacuum erection device, any type, replacement only, each
- L8000Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type
- L8001Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type
- L8002Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type
- L8010Breast prosthesis, mastectomy sleeveterminated
- L8015External breast prosthesis garment, with mastectomy form, post mastectomy
- L8020Breast prosthesis, mastectomy form
- L8031Breast prosthesis, silicone or equal, with integral adhesive
- L8032Nipple prosthesis, prefabricated, reusable, any type, each
- L8033Nipple prosthesis, custom fabricated, reusable, any material, any type, each
- L8035Custom breast prosthesis, post mastectomy, molded to patient model
- L8039Breast prosthesis, not otherwise specified
- L8040Nasal prosthesis, provided by a non-physician
- L8041Midfacial prosthesis, provided by a non-physician
- L8042Orbital prosthesis, provided by a non-physician
Questions about L8030
What is HCPCS code L8030?
L8030 is a HCPCS Level II code for breast prosthesis, silicone or equal, without integral adhesive. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L8030?
The CMS HCPCS file marks L8030 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.