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.

Customize your policy alerts

Sign up for hcpcs L8015 policy alerts

Get alerted when payer policies referencing L8015 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Explore openpayer tools

View all tools

HCPCS L8015: External Breast Prosthesis Garment, Post Mastectomy

Customize your policy alerts

Sign up for hcpcs L8015 policy alerts

Get alerted when payer policies referencing L8015 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

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 Code	Description	Relationship to This Procedure
`19303`	Mastectomy, simple, complete	Surgical procedure that often precedes prescription for an external breast prosthesis.
`19307`	Mastectomy, modified radical	More extensive mastectomy; patients commonly require external prostheses postoperatively.
`11970`	Replacement of tissue expander with permanent implant	Reconstructive option that may be performed instead of or prior to prosthesis use; prosthesis may be temporary adjunct.
`99213`	Office or other outpatient visit, established patient	Common clinical visit code for the surgeon or primary clinician documenting need and writing the prescription for the prosthesis.
`97760`	Orthotic and prosthetic training, upper limb, lower limb, trunk, and/or spinal orthosis	Analogous 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

Modifier	Description	When to Use
52	Modifier ‑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…
59	Modifier 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…
27	Modifier 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…
P1	Modifier 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).…
P3	Modifier 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	Specialty	Notes
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
2278P1004X	Pulmonary Diagnostics Certified Respiratory Therapist	Included in the area of pulmonary diagnostics are the following; collection and analysis of physiological specimens, interpretation of physiological d…
1744R1103X	Research Study Abstracter/Coder	Other Service Providers · Specialist
261QA1903X	Ambulatory Surgical Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
374U00000X	Home Health Aide	A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes.
247100000X	Radiologic Technologist	A medical imaging or radiation therapy professional who is appropriately educated and trained to perform medical imaging procedures using ionizing and…

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

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

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 Code	Description	Relationship to This Procedure
`19303`	Mastectomy, simple, complete	Surgical procedure that often precedes prescription for an external breast prosthesis.
`19307`	Mastectomy, modified radical	More extensive mastectomy; patients commonly require external prostheses postoperatively.
`11970`	Replacement of tissue expander with permanent implant	Reconstructive option that may be performed instead of or prior to prosthesis use; prosthesis may be temporary adjunct.
`99213`	Office or other outpatient visit, established patient	Common clinical visit code for the surgeon or primary clinician documenting need and writing the prescription for the prosthesis.
`97760`	Orthotic and prosthetic training, upper limb, lower limb, trunk, and/or spinal orthosis	Analogous 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

Modifier	Description	When to Use
52	Modifier ‑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…
59	Modifier 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…
27	Modifier 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…
P1	Modifier 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).…
P3	Modifier 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	Specialty	Notes
207K00000X	Allergy & Immunology Physician	An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
2278P1004X	Pulmonary Diagnostics Certified Respiratory Therapist	Included in the area of pulmonary diagnostics are the following; collection and analysis of physiological specimens, interpretation of physiological d…
1744R1103X	Research Study Abstracter/Coder	Other Service Providers · Specialist
261QA1903X	Ambulatory Surgical Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
374U00000X	Home Health Aide	A person trained to assist public health nurses, home health nurses, and other health professionals in the bedside care of patients in their homes.
247100000X	Radiologic Technologist	A medical imaging or radiation therapy professional who is appropriately educated and trained to perform medical imaging procedures using ionizing and…

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

Frequently Asked Questions

References

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.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.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.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS L8015: External Breast Prosthesis Garment, Post Mastectomy

Sign up for hcpcs L8015 policy alerts

OpenPayer

HCPCS L8015: External Breast Prosthesis Garment, Post Mastectomy

Sign up for hcpcs L8015 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS L8015: External Breast Prosthesis Garment, Post Mastectomy

Sign up for hcpcs L8015 policy alerts

HCPCS L8015: External Breast Prosthesis Garment, Post Mastectomy

Sign up for hcpcs L8015 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code L8015 represent and when is it used?

Where is the L8015 prosthesis typically provided or fitted?

What documentation and administrative steps are described for dispensing L8015?

Which modifiers are commonly used when billing L8015?

Which related CPT and diagnosis codes should be referenced with claims for an external breast prosthesis (L8015)?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What does HCPCS code L8015 represent and when is it used?

Where is the L8015 prosthesis typically provided or fitted?

What documentation and administrative steps are described for dispensing L8015?

Which modifiers are commonly used when billing L8015?

Which related CPT and diagnosis codes should be referenced with claims for an external breast prosthesis (L8015)?

References