Question 1

What is HCPCS code L8001?

Accepted Answer

HCPCS code L8001 is "Breast prosthesis bra & form". Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type

Question 2

What category is L8001 in?

Accepted Answer

L8001 belongs to HCPCS Category L (Orthotics and Prosthetics).

Question 3

When should I use HCPCS code L8001?

Accepted Answer

Use L8001 when billing for breast prosthesis bra & form. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is L8001 covered by Medicare?

Accepted Answer

Coverage for L8001 (Breast prosthesis bra & form) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for L8001?

Accepted Answer

Documentation for L8001 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).