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    v1.0.31
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l8015-external-breast-prosthesis-garment-post-mastectomy
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    HCPCS L8015: External Breast Prosthesis Garment, Post Mastectomy

    HCPCS Level II code L8015 describes an external breast prosthesis garment with a mastectomy form intended for post-mastectomy use; the service is provision of a breast prosthesis garment (prosthetic garment with pocketed mastectomy form) and the typical site of service is outpatient durable medical equipment supply or a prosthetics/orthotics clinic where fitting and dispensing occur.

    For related coverage guidance, see recent payer policy updates: Speech Therapy for Autism Disorders - Medical Policy, Physical Performance Test or Measurement, Sensory Integration Therapy and Auditory Integration Training.

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    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old woman presents to an outpatient durable medical equipment (DME) supplier following a unilateral mastectomy performed for stage I infiltrating ductal carcinoma. The surgeon’s office provides a prescription for an external breast prosthesis garment with a mastectomy form. The patient is evaluated in the DME clinic for size, laterality, and fit; measurements and documentation of medical necessity are obtained and scanned into the patient chart. The supplier verifies insurance coverage, submits prior authorization if required, and dispenses the prosthesis with instructions for care and proper wear. Follow-up occurs as needed for fit adjustments or replacement due to weight change or wear.

    • Service Type: External breast prosthesis garment with mastectomy form (L8015) provided as durable medical equipment (prosthetic garment).

    • Typical Site of Service: Outpatient DME supplier clinic, hospital outpatient prosthetics department, or specialty breast prosthesis/mastectomy boutique.

    • Typical Patient Scenario: Post-mastectomy patient requiring a post-mastectomy external prosthesis for symmetry, psychosocial rehabilitation, and clothing fit following unilateral or bilateral mastectomy. Documentation includes surgical history, laterality, prescription, and proof of medical necessity.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    19303Mastectomy, simple, completeSurgical procedure that often precedes prescription for an external breast prosthesis.
    19307Mastectomy, modified radicalMore extensive mastectomy; patients commonly require external prostheses postoperatively.
    11970Replacement of tissue expander with permanent implantReconstructive option that may be performed instead of or prior to prosthesis use; prosthesis may be temporary adjunct.
    99213Office or other outpatient visit, established patientCommon clinical visit code for the surgeon or primary clinician documenting need and writing the prescription for the prosthesis.
    97760Orthotic and prosthetic training, upper limb, lower limb, trunk, and/or spinal orthosisAnalogous training/education CPT for prosthetic use—education and fitting activities for external prostheses may be documented under prosthetic supplier visit notes (billing practice varies).

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    27Modifier 27 indicates a separate, subsequent outpatient hospital E/M service provided to the same patient on the same date by a different provider in a hospital outpatient setting. It is a…- Use modifier -27 on facility (hospital outpatient/ambulatory service center) claims to report a subsequent, separate, and distinct outpatient E/M service provided to the same patient on the same…
    P1Modifier P1 indicates an ASA Physical Status I — a normal healthy patient — and is appended to anesthesia CPT codes (00100–01999) based on the anesthesiologist’s clinical assessment. It documents the…- When to apply: Use modifier P1 on anesthesia CPT codes (00100–01999) when the anesthesia provider assigns ASA Physical Status I — a normal healthy patient (non‑smoker, minimal or no alcohol use).…
    P3Modifier P3 denotes that the anesthesia patient has severe systemic disease (ASA III). It applies only to anesthesia CPT codes (00100–01999) and must be appended by the anesthesia provider with…- Applies only to anesthesia procedure codes (CPT 00100–01999) and should be appended by the anesthesia provider when the patient meets the definition of "severe systemic disease" (CPT/AAPC P3;…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    207L00000X
    207Q00000X
    2278P1004X
    1744R1103X
    261QA1903X
    374U00000X
    247100000X

    Related Payer Policy Updates

    Specialty: Physical Medicine, Rehab & Therapies1 / 2

    10 rows

    PolicyPayerEffective Date
    Speech Therapy for Autism Disorders - Medical PolicyHealth-New-England2026-12-01
    Physical Performance Test or MeasurementCigna2026-11-15
    Sensory Integration Therapy and Auditory Integration TrainingColorado Rocky Mountain Health Plans2026-11-01
    Skilled Nursing and Skilled Rehabilitation Services (Outpatient)Anthem2026-10-01
    Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only)UnitedHealthcare2026-10-01
    Physical Therapy/Medicine Corporate Medical Policybcbsvermont2026-10-01
    Cognitive Rehabilitation Corporate Medical Policybcbsvermont2026-10-01
    Speech Language Pathology/Therapy Services Corporate Medical Policybcbsvermont2026-10-01
    Occupational Therapy Corporate Medical Policybcbsvermont2026-10-01
    Biomagnetic TherapyConnectiCare2026-09-11

    Related Codes

    HCPCS-L5000-PARTIAL-FOOT-SHOE-INSERT-LONGITUDINAL-ARCH-TOE-FILLER

    HCPCS Level II L5000: Partial Foot Shoe Insert with Longitudinal Arch, Toe Filler

    HCPCS-L5010-PARTIAL-FOOT-MOLDED-SOCKET-ANKLE-HEIGHT-TOE-FILLER

    HCPCS L5010: Partial Foot Molded Socket, Ankle Height, With Toe Filler

    HCPCS-L5020-PARTIAL-FOOT-MOLDED-SOCKET-TIBIAL-TUBERCLE-TOE-FILLER

    HCPCS L5020: Partial Foot Molded Socket with Toe Filler

    HCPCS-L5050-ANKLE-SYMES-MOLDED-SOCKET-SACH-FOOT

    HCPCS L5050: Ankle/Symes Molded Socket with SACH Foot

    HCPCS-L5060-ANKLE-SYMES-METAL-FRAME-MOLDED-LEATHER-SOCKET-ARTICULATED-ANKLE-FOOT

    HCPCS L5060: Ankle/Symes Metal Frame with Molded Leather Socket

    HCPCS-L5100-BELOW-KNEE-MOLDED-SOCKET-SHIN-SACH-FOOT

    HCPCS Level II L5100: Below-Knee Molded Socket with Shin and SACH Foot

    HCPCS-L5105-BELOW-KNEE-PLASTIC-SOCKET-SACH-FOOT

    HCPCS L5105: Below-Knee Plastic Socket Prosthesis with SACH Foot

    HCPCS-L5150-KNEE-DISARTICULATION-MOLDED-SOCKET-EXTERNAL-KNEE-SACH-FOOT

    HCPCS L5150: Knee Disarticulation Molded Socket with External Knee and SACH Foot

    HCPCS-L5160-KNEE-DISARTICULATION-MOLDED-SOCKET-BENT-KNEE-SACH-FOOT

    HCPCS Level II L5160: Knee Disarticulation Molded Socket, Bent Knee Configuration

    HCPCS-L5200-ABOVE-KNEE-MOLDED-SOCKET-SINGLE-AXIS-KNEE-SACH-FOOT

    HCPCS Level II L5200: Above-knee Prosthesis with Molded Socket and Single-axis Knee

    Showing 1–10 of 472

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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