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See a sample rate comparisonHCPCS L8042 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.
Orbital prosthesis, provided by a non-physician
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Facial and External Ear Prosthetics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L8042 |
National average reimbursement for HCPCS L8042 by major payers:
$3,407.34
$2,214.88
$2,398.93
$4,085.74
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HCPCS L8042
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$7,812.62Published rateEmory Healthcare
Emory University
$2,280.79Published rateBrittany Ptachick
Hroa 401k Plan
$1,927.64Published rateThe Hospital Authority Of Monroe County, Georgia, Monroe County Hospital
The Hospital Authority Of Monroe County Georgia
$1,074.92Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$531.10Published rate
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See a sample payer proposalHCPCS L8042 vs. Other Facial and External Ear Prosthetics Codes
The HCPCS L8042 code is part of the Prosthetic Procedures services used for Facial and External Ear Prosthetics. 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 L8042 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 |
|---|---|---|
| L8041-HCPCS | High | Midfacial prosthesis, provided by a non-physician |
| L8042-HCPCS | High | Orbital prosthesis, provided by a non-physician |
| L8043-HCPCS | High | Upper facial prosthesis, provided by a non-physician |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L8042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L8042 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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