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See a sample rate comparisonHCPCS L8030 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, silicone or equal, without integral adhesive
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Breast Prosthetics and Accessories |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L8030 |
National average reimbursement for HCPCS L8030 by major payers:
$337.84
$225.21
$241.41
$499.75
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HCPCS L8030
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$923.53Published rateThe Hospital Authority Of Monroe County, Georgia, Monroe County Hospital
The Hospital Authority Of Monroe County Georgia
$267.70Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$229.11Published rateEvans Memorial Hospital, Inc.
Evans Memorial Hospital Inc
$189.22Published rateWildwood Sanitarium, Incorporated, Wildwood Lifestyle Center And Hospital
Wildwood Sanitarium Incorporated
$131.63Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L8030 vs. Other Breast Prosthetics and Accessories Codes
The HCPCS L8030 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 L8030 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 |
|---|---|---|
| L8020-HCPCS | Moderate | Breast prosthesis, mastectomy form |
| L8030-HCPCS | Moderate | Breast prosthesis, silicone or equal, without integral adhesive |
| L8031-HCPCS | Moderate | Breast prosthesis, silicone or equal, with 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 L8030. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L8030 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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