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See a sample rate comparisonHCPCS L8035 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Custom breast prosthesis, post mastectomy, molded to patient model
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Breast Prosthetics and Accessories |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L8035 |
National average reimbursement for HCPCS L8035 by major payers:
$3,630.85
$2,374.79
$2,610.42
$5,260.14
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HCPCS L8035
5 of 25 sample ratesHigher to lower in this preview
Emory Healthcare
Emory University
$7,507.41Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$3,557.37Published rateEvans Memorial Hospital, Inc.
Evans Memorial Hospital Inc
$2,125.83Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$1,931.27Published rateWildwood Sanitarium Incorporated, Wildwood Medical Clinic
Wildwood Sanitarium Incorporated
$1,478.95Published rate
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See a sample payer proposalHCPCS L8035 vs. Other Breast Prosthetics and Accessories Codes
The HCPCS L8035 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 L8035 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 |
|---|---|---|
| L8033-HCPCS | Low | Nipple prosthesis, custom fabricated, reusable, any material, any type, each |
| L8035-HCPCS | High | Custom breast prosthesis, post mastectomy, molded to patient model |
| L8039-HCPCS | Low | Breast prosthesis, not otherwise specified |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L8035. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L8035 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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