HCPCS Range Breast Prosthetics and Accessories

• 1 Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type ( L8000 )

• 2 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type ( L8001 )

• 3 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type ( L8002 )

• 4 Breast prosthesis, mastectomy sleeve ( L8010 )

• 5 External breast prosthesis garment, with mastectomy form, post mastectomy ( L8015 )

• 6 Breast prosthesis, mastectomy form ( L8020 )

• 7 Breast prosthesis, silicone or equal, without integral adhesive ( L8030 )

• 8 Breast prosthesis, silicone or equal, with integral adhesive ( L8031 )

• 9 Nipple prosthesis, prefabricated, reusable, any type, each ( L8032 )

• 10 Custom breast prosthesis, post mastectomy, molded to patient model ( L8035 )

• 11 Breast prosthesis, not otherwise specified ( L8039 )

• 12 Nipple prosthesis, custom fabricated, reusable, any material, any type, each ( L8033 )