L8642: Hallux implant
L8642 is a HCPCS Level II code for hallux implant. 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 2026Q4-Oct. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits: units per day
The most units of L8642 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
- 2 units MAI 3: Date of Service Edit: Clinical · Anatomic Consideration
- outpatient
- 2 units MAI 3: Date of Service Edit: Clinical · Anatomic Consideration
- DME supplier
- 0, never payable MAI 3: Date of Service Edit: Clinical · CMS Policy
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 2026Q4.
The CMS record for L8642
- Long descriptor
- Hallux implant
- Short descriptor
- Hallux implant
- Added
- January 1, 1992
- 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 L8642
HCPCS has no hierarchy: related items simply sit next to each other in the numbering. If L8642 is not quite right, the correct code is very often within a few positions of it.
- L8624Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each
- L8625External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each
- L8627Cochlear implant, external speech processor, component, replacement
- L8628Cochlear implant, external controller component, replacement
- L8629Transmitting coil and cable, integrated, for use with cochlear implant device, replacement
- L8630Metacarpophalangeal joint implant
- L8631Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system)
- L8641Metatarsal joint implant
- L8658Interphalangeal joint spacer, silicone or equal, each
- L8659Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size
- L8670Vascular graft material, synthetic, implant
- L8678Electrical stimulator supplies (external) for use with implantable neurostimulator, per month
- L8679Implantable neurostimulator, pulse generator, any type
- L8680Implantable neurostimulator electrode, each
- L8681Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only
- L8682Implantable neurostimulator radiofrequency receiver