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See a sample rate comparisonHCPCS L8020 Fee Schedule
Last Verified: October 2026
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.
Breast prosthesis, mastectomy form
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Breast Prosthetics and Accessories |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L8020 |
National average reimbursement for HCPCS L8020 by major payers:
$230.81
$148.59
$162.90
$321.43
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HCPCS L8020
5 of 25 sample ratesHigher to lower in this preview
Grady Memorial Hospital Corporation, Grady Health Systems
Emory University
$392.70Published rateMeriwether County Hospital Authority, Warm Springs Medical Center
Meriwether Healthcare, LLC D/B/A Warm Springs Medical Center
$136.50Published rateQuest Diagnostics LLC Il
$125.40Published rateNorthside Hospital, Inc., Northside Hospital Duluth
$118.84Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$112.80Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L8020 vs. Other Breast Prosthetics and Accessories Codes
The HCPCS L8020 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 L8020 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 |
|---|---|---|
| L8015-HCPCS | Low | External breast prosthesis garment, with mastectomy form, post mastectomy |
| L8020-HCPCS | Moderate | Breast prosthesis, mastectomy form |
| L8030-HCPCS | Moderate | Breast prosthesis, silicone or equal, without integral adhesive |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L8020. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L8020 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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