HCPCS L8000 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Prosthetic Procedures • Breast Prosthetics and Accessories |
| Common Place of Service | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for HCPCS L8000 by major payers:
$42.72
$26.48
$29.49
$60.27
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS L8000 | ||||||
United | L8000 | $81.63 | 1073502985 - CHU CHEN | 42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | L8000 | $27.78 | 1851400485 - GEORGE HEMSTREET | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Interventional Cardiology Physician (207RI0011X) |
United | L8000 | $81.63 | 1073502985 - CHU CHEN | 42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | L8000 | $16.27 | 1023055126 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR CENTENNIAL MEDICAL CENTER | 382084239 - QUEST DIAGNOSTICS CLINICAL LABORATORIES, INC. | TN | General Acute Care Hospital (282N00000X) |
United | L8000 | $39.68 | 1487721718 - VICTORIA LEWIS-HOLLAND | 586011888 | GA | General Acute Care Hospital (282N00000X) |
United | L8000 | $24.79 | 1790942381 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM MEDICAL CENTER - TATTNALL | 300466706 | GA | Critical Access Hospital (282NC0060X) |
United | L8000 | $16.27 | 1366479099 - UNILAB CORPORATION, QUEST DIAGNOSTICS CLINICAL LAB | 710897031 | CA | Clinical Medical Laboratory (291U00000X) |
United | L8000 | $22.93 | 1760452098 - HOSPITAL AUTHORITY OF JENKINS COUNTY | 273100894 | GA | Critical Access Hospital (282NC0060X) |
United | L8000 | $25.23 | 1235306648 - ST. FRANCIS RADIOLOGISTS, LLC | 475419443 | GA | General Acute Care Hospital (282N00000X) |
United | L8000 | $29.76 | 1043265564 - MONROE HMA, LLC, CLEARVIEW REGIONAL MEDICAL CENTER | 200141568 - (GA) MONROE HMA LLC | GA | General Acute Care Hospital (282N00000X) |
United | L8000 | $26.32 | 1841651056 - KAMRAN RAJAEE | 273818647 | GA | General Acute Care Hospital (282N00000X) |
United | L8000 | $22.93 | 1326191180 - PROFESSIONAL RESOURCES MANAGEMENT OF RABUN, LLC, MOUNTAIN LAKES MEDICAL CENTER | 202012765 | GA | Critical Access Hospital (282NC0060X) |
United | L8000 | $22.93 | 1720189517 - TAYLOR REGIONAL HOSPITAL | 580655369 - (GA) TAYLOR REGIONAL HOSPITAL | GA | Rural Acute Care Hospital (282NR1301X) |
United | L8000 | $23.92 | 1184771586 - LOWER OCONEE COMMUNITY HOSPITAL INC | 208897263 | GA | Critical Access Hospital (282NC0060X) |
United | L8000 | $29.20 | 1881630614 - QUEST DIAGNOSTICS LLC IL | 364257926 | IL | Clinical Medical Laboratory (291U00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS L8000 vs. Other Breast Prosthetics and Accessories Codes
The HCPCS L8000 code is part of the Prosthetic Procedures services used for Breast Prosthetics and Accessories. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS L8000 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| L7902 | Low | Tension ring, for vacuum erection device, any type, replacement only, each |
| L8000 | Low | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
| L8001 | Low | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L8000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L8000 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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