Summary & Overview
HCPCS L8000: Mastectomy Bra Without Integrated Prosthesis Form
HCPCS Level II code L8000 denotes a mastectomy bra without an integrated breast prosthesis form, intended to support an external prosthesis after mastectomy or other breast surgery. Nationally, this code matters because it covers a common post-surgical support garment that affects patient comfort, prosthesis use, and durable medical equipment billing workflows. Coverage and reimbursement practices for this garment influence access to post-mastectomy supplies and the billing practices of suppliers and clinicians.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise look at how the code is defined, the typical sites of service for provision, and the practical clinical context for use. The publication presents benchmarks and billing considerations tied to L8000, highlights common policy themes across major payers, and outlines where to find applicable coverage details.
This summary equips billing managers, DME suppliers, clinic administrators, and policy analysts with the essential facts about code L8000, the service it represents, and the payer landscape that determines coverage and claims processing for mastectomy support garments.
Billing Code Overview
HCPCS Level II code L8000 describes a mastectomy bra without an integrated breast prosthesis form, usable in any size and any type. The item is intended as an external post-mastectomy garment that provides support and holds a removable prosthesis (prosthesis not included with this code).
Service type: Breast prosthesis support garment (mastectomy bra)
Typical site of service: Durable medical equipment supply, outpatient medical supply stores, specialist clinics, and home use following mastectomy or breast surgery
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman status post unilateral or bilateral mastectomy for breast cancer who requires external breast prosthesis and a mastectomy bra to accommodate the prosthesis. The patient visits an outpatient durable medical equipment or prosthetics clinic, breast center, or specialty medical supply vendor. Clinical workflow: clinician documents medical necessity in the chart (e.g., history of mastectomy, current prosthesis need, skin integrity, and laterality). A prescription or order for a mastectomy bra without integrated prosthetic form is provided. The vendor verifies insurance coverage and beneficiary eligibility (for example, Medicare, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA), selects appropriate size and type, fits the patient in the mastectomy bra, and dispenses the item. Education is provided on wear, care, and follow-up for changes in fit or post-surgical changes. Billing uses HCPCS Level II code L8000 and may include a modifier for laterality, place of service, or replacement circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when item is specific to the left breast or documented left mastectomy |
RT |