Summary & Overview
HCPCS L8002: Breast Prosthesis Mastectomy Bra with Integrated Form, Bilateral
HCPCS Level II code L8002 identifies a combined mastectomy bra with an integrated breast prosthesis form for bilateral use. This code captures a specialized prosthetic garment intended to restore form and support after bilateral mastectomy and is relevant across surgical recovery, durable medical equipment policy, and prosthetics coverage nationally. Coverage and billing of L8002 affect access to post‑mastectomy supplies for patients managing reconstructive needs outside of surgical settings.
Key payers discussed in this overview include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a national perspective on how this HCPCS Level II code is used in prosthetics supply chains, typical settings where the item is provided, and the clinical context surrounding post‑mastectomy prosthetic fittings. The publication reviews common billing and coding considerations, payer coverage patterns, and benchmarking information where available. It also summarizes implications for suppliers and clinicians involved in prosthetic provisioning and outpatient fitting services.
This brief provides actionable reference material for billing staff, prosthetics suppliers, and policy analysts seeking concise guidance about the code's clinical role, service setting, and the range of payers that commonly process claims for bilateral integrated breast prosthesis garments. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code L8002 describes a breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type. This item is a combined prosthetic garment and prosthesis designed for patients who have undergone bilateral mastectomy.
Service Type: Prosthetic supply / durable medical equipment
Typical Site of Service: Outpatient durable medical equipment suppliers, prosthetics and orthotics clinics, specialty retail medical supply locations, and post‑surgical outpatient fitting services
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman post-mastectomy seeking external breast replacement for body contour symmetry and prosthetic support. A 58-year-old patient who underwent unilateral or bilateral mastectomy for breast cancer during prior months presents to a durable medical equipment (DME) supplier or specialty prosthetics clinic for fitting. The clinician (prosthetist, certified mastectomy fitter, or DME supplier) assesses healed surgical sites, residual limb contours, and any lymphedema or radiotherapy-related skin changes. Measurements are taken and a mastectomy bra with integrated bilateral prosthetic forms is selected or custom ordered. Documentation includes surgical history (mastectomy laterality and date), physician prescription for a mastectomy bra with integrated prosthesis L8002, clinical justification (need for external breast form for symmetry, comfort, and prosthetic support), fit notes, size/type selected, and delivery date. Typical workflow: physician prescription → referral to prosthetic fitter/DME → clinical assessment and measurement → selection or custom fabrication → delivery and patient education on wear/skin care → billing to applicable payor with appropriate modifiers and diagnosis codes reflecting mastectomy and cancer history.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Data not available in the input. | Data not available in the input. |