HCPCS Level II L8039: Breast Prosthesis, Not Otherwise Specified

HCPCS Level II code L8039 describes a breast prosthesis, not otherwise specified, representing an external prosthetic device used after mastectomy or breast surgery; the service type is prosthetic supply and the typical site of service is outpatient clinic, surgical center, or home health settings where external breast forms are fitted or supplied.

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HCPCS Level II L8039: Breast Prosthesis, Not Otherwise Specified

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Get alerted when payer policies referencing L8039 are released or updated.

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Clinical & Coding Specifications

Clinical Context

A typical patient is a woman who has undergone mastectomy for breast cancer or prophylactic mastectomy and requires external breast prosthesis fitting. The patient presents to a certified mastectomy fitter or a breast clinic for a post-operative prosthesis evaluation. The clinical workflow includes: pre-visit chart review of surgical and oncologic history, measurement and assessment of the chest wall and contralateral breast, selection of an appropriate external prosthesis style and size, trial fittings, patient education on use and care of the prosthesis, documentation of medical necessity (mastectomy or congenital absence), and issuance of the prosthesis. The device billed as L8039 (breast prosthesis, not otherwise specified) is supplied after clinical confirmation of need, and may be billed by durable medical equipment suppliers, prosthetic services, or outpatient clinics. Typical sites of service include outpatient prosthetic and orthotic clinics, hospital outpatient departments, and physician office-based fitting services. Patient scenarios include unilateral or bilateral mastectomy, congenital breast deformity, or significant breast tissue loss due to trauma, where a custom or stock external prosthesis is selected but does not fit more specific HCPCS categories.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19357`	Breast reconstruction, with or without prosthetic implant, immediate or delayed	Surgical reconstruction option that may precede or replace need for external prosthesis fitting
`15777`	Application of tissue sealant (e.g., fibrin) during wound closure (used when applicable)	Used intraoperatively by surgeons who perform mastectomy/reconstruction before prosthesis need
`99203`	Office or other outpatient visit for new patient, typically 30 minutes	Pre-fitting evaluation visit for assessment and medical necessity documentation
`97760`	Orthotic management and training, initial encounter	Training and fitting services when prosthetic education and functional training are provided
`99070`	Supplies and materials (unless otherwise specified)	Used when billing for non-covered supplies related to the fitting or patient education

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…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
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…
251J00000X	Nursing Care Agency	A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (L…
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…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
3418M1120X	Military or U.S. Coast Guard Air Transport Ambulance	Vehicle and staff for patient emergency or non-emergency air transport.
207ZC0006X	Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
213EG0000X	Deactivated - Podiatrist
207U00000X	Nuclear Medicine Physician	A nuclear medicine specialist employs the properties of radioactive atoms and molecules in the diagnosis and treatment of disease and in research. Rad…

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.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`19357`	Breast reconstruction, with or without prosthetic implant, immediate or delayed	Surgical reconstruction option that may precede or replace need for external prosthesis fitting
`15777`	Application of tissue sealant (e.g., fibrin) during wound closure (used when applicable)	Used intraoperatively by surgeons who perform mastectomy/reconstruction before prosthesis need
`99203`	Office or other outpatient visit for new patient, typically 30 minutes	Pre-fitting evaluation visit for assessment and medical necessity documentation
`97760`	Orthotic management and training, initial encounter	Training and fitting services when prosthetic education and functional training are provided
`99070`	Supplies and materials (unless otherwise specified)	Used when billing for non-covered supplies related to the fitting or patient education

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…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
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…
251J00000X	Nursing Care Agency	A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (L…
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…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
3418M1120X	Military or U.S. Coast Guard Air Transport Ambulance	Vehicle and staff for patient emergency or non-emergency air transport.
207ZC0006X	Clinical Pathology Physician	A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
213EG0000X	Deactivated - Podiatrist
207U00000X	Nuclear Medicine Physician	A nuclear medicine specialist employs the properties of radioactive atoms and molecules in the diagnosis and treatment of disease and in research. Rad…

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 Level II L8039: Breast Prosthesis, Not Otherwise Specified

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HCPCS Level II L8039: Breast Prosthesis, Not Otherwise Specified

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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 Level II L8039: Breast Prosthesis, Not Otherwise Specified

Sign up for hcpcs L8039 policy alerts

HCPCS Level II L8039: Breast Prosthesis, Not Otherwise Specified

Sign up for hcpcs L8039 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical situations and sites of service are appropriate for billing HCPCS L8039?

Which modifiers are commonly used with L8039 and when should they be applied?

What diagnoses and documentation support medical necessity for billing L8039?

Are there related CPT or surgical codes to consider when billing for an external breast prosthesis?

Which payers are referenced and where should billers look for coverage or prior authorization details?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What clinical situations and sites of service are appropriate for billing HCPCS L8039?

Which modifiers are commonly used with L8039 and when should they be applied?

What diagnoses and documentation support medical necessity for billing L8039?

Are there related CPT or surgical codes to consider when billing for an external breast prosthesis?

Which payers are referenced and where should billers look for coverage or prior authorization details?

References