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    v1.0.31
    OpenPayerBilling CodesProsthetic ProceduresHCPCS hcpcs-l8031-breast-prosthesis-silicone-integral-adhesive
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    HCPCS Level II L8031: Breast Prosthesis, Silicone with Integral Adhesive

    HCPCS Level II code L8031 describes a breast prosthesis, silicone or equal, with integral adhesive intended as an external prosthetic device to replace breast contour after mastectomy; the service type is prosthetic device supply, and the typical site of service is outpatient clinics, durable medical equipment suppliers, or post-surgical reconstructive care settings.

    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 52-year-old woman presents to the breast prosthetics clinic following a unilateral mastectomy for invasive ductal carcinoma with completion of adjuvant therapy. She seeks external breast reconstruction options and is fitted for a silicone breast prosthesis with integral adhesive to provide secure adherence to the chest wall and a natural contour under clothing. The clinical workflow includes: pre-fit assessment by a certified prosthetist or oncology nurse (measurement of chest wall dimensions, scar assessment, and skin integrity), selection of prosthesis size and shape, trial fitting with adhesive-backed prosthesis, patient education on application and daily wear, documentation of medical necessity tied to the mastectomy, issuance of the device with supplier information, and scheduled follow-up to reassess fit and address skin irritation or changes in body habitus. Typical sites of service: outpatient prosthetics clinic, durable medical equipment supplier location, oncology clinic, or home health setup for patients with mobility limitations. Typical patient scenario: post-mastectomy external breast prosthesis fitting for cosmetic symmetry and psychosocial rehabilitation after breast cancer surgery; may also be used for congenital breast absence or traumatic loss of breast tissue.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    15877Application of tissue adhesive (e.g., Dermabond) for closure, trunk; simpleData not available in the input
    99070Supplies and materials (except spectacles) provided by the physician over and above those usually included with the office visitData not available in the input
    97760Orthotic management and training, upper extremity, lower extremity, trunk, and/or custom fitting of orthotic deviceData not available in the input

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    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…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    363LA2200X
    163WW0000X
    332G00000X
    2084N0402X
    246QH0600X
    347C00000X
    136A00000X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    C50.911Malignant neoplasm of unspecified site of right female breast
    C50.912Malignant neoplasm of unspecified site of left female breast
    C50.919Malignant neoplasm of unspecified site of unspecified female breast
    D05.10Intraductal carcinoma in situ of unspecified breast
    D05.11Intraductal carcinoma in situ of right breast
    D05.90Unspecified type of carcinoma in situ of unspecified breast
    D05.91Unspecified type of carcinoma in situ of right breast
    M35.3Polymyalgia rheumatica
    N64.0Fissure and fistula of nipple
    N64.1Fat necrosis of breast

    Showing 1–10 of 21

    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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