| Code | Description | States | Median rate |
|---|---|---|---|
| L8000 | Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type | 45 | $35.76 |
| L8001 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type | 39 | $120.62 |
| L8002 | Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type | 39 | $158.62 |
| L8015 | External breast prosthesis garment, with mastectomy form, post mastectomy | 41 | $56.23 |
| L8020 | Breast prosthesis, mastectomy form | 44 | $205.87 |
| L8030 | Breast prosthesis, silicone or equal, without integral adhesive | 44 | $317.14 |
| L8031 | Breast prosthesis, silicone or equal, with integral adhesive | 28 | $333.71 |
| L8032 | Nipple prosthesis, prefabricated, reusable, any type, each | 23 | $38.66 |
| L8035 | Custom breast prosthesis, post mastectomy, molded to patient model | 33 | $3,522.49 |
| L8040 | Nasal prosthesis, provided by a non-physician | 26 | $2,399.79 |
| L8041 | Midfacial prosthesis, provided by a non-physician | 27 | $2,910.83 |
| L8042 | Orbital prosthesis, provided by a non-physician | 28 | $3,231.23 |
| L8043 | Upper facial prosthesis, provided by a non-physician | 26 | $3,800.58 |
| L8044 | Hemi-facial prosthesis, provided by a non-physician | 26 | $4,207.77 |
| L8045 | Auricular prosthesis, provided by a non-physician | 25 | $2,780.00 |
| L8046 | Partial facial prosthesis, provided by a non-physician | 26 | $2,584.97 |
| L8047 | Nasal septal prosthesis, provided by a non-physician | 27 | $1,340.94 |
| L8049 | Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician | 14 | $19.94 |
| L8300 | Truss, single with standard pad | 43 | $82.62 |
| L8310 | Truss, double with standard pads | 42 | $135.29 |
| L8320 | Truss, addition to standard pad, water pad | 41 | $52.70 |
| L8330 | Truss, addition to standard pad, scrotal pad | 40 | $48.35 |
| L8400 | Prosthetic sheath, below knee, each | 44 | $17.02 |
| L8410 | Prosthetic sheath, above knee, each | 44 | $21.33 |
| L8415 | Prosthetic sheath, upper limb, each | 44 | $20.62 |
| L8417 | Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each | 42 | $68.54 |
| L8420 | Prosthetic sock, multiple ply, below knee, each | 44 | $19.48 |
| L8430 | Prosthetic sock, multiple ply, above knee, each | 44 | $21.90 |
| L8435 | Prosthetic sock, multiple ply, upper limb, each | 45 | $20.59 |
| L8440 | Prosthetic shrinker, below knee, each | 45 | $41.01 |
| L8460 | Prosthetic shrinker, above knee, each | 44 | $65.27 |
| L8465 | Prosthetic shrinker, upper limb, each | 45 | $48.76 |
| L8470 | Prosthetic sock, single ply, fitting, below knee, each | 44 | $6.54 |
| L8480 | Prosthetic sock, single ply, fitting, above knee, each | 44 | $9.02 |
| L8485 | Prosthetic sock, single ply, fitting, upper limb, each | 44 | $11.33 |
| L8500 | Artificial larynx, any type | 41 | $666.23 |
| L8501 | Tracheostomy speaking valve | 43 | $118.30 |
| L8507 | Tracheo-esophageal voice prosthesis, patient inserted, any type, each | 30 | $40.16 |
| L8509 | Tracheo-esophageal voice prosthesis, inserted by a licensed health care provider, any type | 30 | $103.84 |
| L8510 | Voice amplifier | 27 | $242.95 |
| L8511 | Insert for indwelling tracheoesophageal prosthesis, with or without valve, replacement only, each | 27 | $71.09 |
| L8512 | Gelatin capsules or equivalent, for use with tracheoesophageal voice prosthesis, replacement only, per 10 | 24 | $2.03 |
| L8513 | Cleaning device used with tracheoesophageal voice prosthesis, pipet, brush, or equal, replacement only, each | 25 | $5.05 |
| L8514 | Tracheoesophageal puncture dilator, replacement only, each | 24 | $88.87 |
| L8515 | Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each | 26 | $59.48 |
| L8600 | Implantable breast prosthesis, silicone or equal | 16 | $646.40 |
| L8603 | Injectable bulking agent, collagen implant, urinary tract, 2.5 ml syringe, includes shipping and necessary supplies | 20 | $428.87 |
| L8605 | Injectable bulking agent, dextranomer/hyaluronic acid copolymer implant, anal canal, 1 ml, includes shipping and necessary supplies | 13 | $675.13 |
| L8606 | Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies | 18 | $224.58 |
| L8607 | Injectable bulking agent for vocal cord medialization, 0.1 ml, includes shipping and necessary supplies | 13 | $42.68 |
| L8609 | Artificial cornea | 18 | $6,390.64 |
| L8610 | Ocular implant | 19 | $617.45 |
| L8612 | Aqueous shunt | 18 | $657.54 |
| L8613 | Ossicula implant | 16 | $292.68 |
| L8614 | Cochlear device, includes all internal and external components | 27 | $18,657.52 |
| L8615 | Headset/headpiece for use with cochlear implant device, replacement | 38 | $420.48 |
| L8616 | Microphone for use with cochlear implant device, replacement | 38 | $99.48 |
| L8617 | Transmitting coil for use with cochlear implant device, replacement | 39 | $85.54 |
| L8618 | Transmitter cable for use with cochlear implant device or auditory osseointegrated device, replacement | 40 | $24.29 |
| L8619 | Cochlear implant, external speech processor and controller, integrated system, replacement | 40 | $8,143.67 |
| L8621 | Zinc air battery for use with cochlear implant device and auditory osseointegrated sound processors, replacement, each | 37 | $0.60 |
| L8622 | Alkaline battery for use with cochlear implant device, any size, replacement, each | 36 | $0.31 |
| L8623 | Lithium ion battery for use with cochlear implant device speech processor, other than ear level, replacement, each | 37 | $58.61 |
| L8624 | Lithium ion battery for use with cochlear implant or auditory osseointegrated device speech processor, ear level, replacement, each | 37 | $146.12 |
| L8625 | External recharging system for battery for use with cochlear implant or auditory osseointegrated device, replacement only, each | 31 | $192.91 |
| L8627 | Cochlear implant, external speech processor, component, replacement | 33 | $6,635.35 |
| L8628 | Cochlear implant, external controller component, replacement | 35 | $1,162.20 |
| L8629 | Transmitting coil and cable, integrated, for use with cochlear implant device, replacement | 34 | $172.14 |
| L8630 | Metacarpophalangeal joint implant | 15 | $333.85 |
| L8631 | Metacarpal phalangeal joint replacement, two or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon), for surgical implantation (all sizes, includes entire system) | 13 | $2,217.72 |
| L8641 | Metatarsal joint implant | 15 | $403.69 |
| L8642 | Hallux implant | 15 | $299.51 |
| L8658 | Interphalangeal joint spacer, silicone or equal, each | 16 | $357.16 |
| L8659 | Interphalangeal finger joint replacement, 2 or more pieces, metal (e.g., stainless steel or cobalt chrome), ceramic-like material (e.g., pyrocarbon) for surgical implantation, any size | 13 | $1,944.01 |
| L8670 | Vascular graft material, synthetic, implant | 14 | $558.28 |
| L8678 | Electrical stimulator supplies (external) for use with implantable neurostimulator, per month | 14 | $12.25 |
| L8679 | Implantable neurostimulator, pulse generator, any type | 21 | $8,676.97 |
| L8680 | Implantable neurostimulator electrode, each | 14 | $356.64 |
| L8681 | Patient programmer (external) for use with implantable programmable neurostimulator pulse generator, replacement only | 18 | $1,122.55 |
| L8682 | Implantable neurostimulator radiofrequency receiver | 15 | $5,921.84 |
| L8683 | Radiofrequency transmitter (external) for use with implantable neurostimulator radiofrequency receiver | 17 | $5,434.41 |
| L8684 | Radiofrequency transmitter (external) for use with implantable sacral root neurostimulator receiver for bowel and bladder management, replacement | 18 | $739.43 |
| L8685 | Implantable neurostimulator pulse generator, single array, rechargeable, includes extension | 12 | $11,894.56 |
| L8686 | Implantable neurostimulator pulse generator, single array, non-rechargeable, includes extension | 12 | $7,589.68 |
| L8687 | Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension | 12 | $13,694.91 |
| L8688 | Implantable neurostimulator pulse generator, dual array, non-rechargeable, includes extension | 12 | $9,831.68 |
| L8689 | External recharging system for battery (internal) for use with implantable neurostimulator, replacement only | 19 | $1,658.49 |
| L8690 | Auditory osseointegrated device, includes all internal and external components | 22 | $4,573.90 |
| L8691 | Auditory osseointegrated device, external sound processor, excludes transducer/actuator, replacement only, each | 39 | $1,894.66 |
| L8692 | Auditory osseointegrated device, external sound processor, used without osseointegration, body worn, includes headband or other means of external attachment | 17 | $2,649.18 |
| L8693 | Auditory osseointegrated device abutment, any length, replacement only | 24 | $1,527.59 |
| L8694 | Auditory osseointegrated device, transducer/actuator, replacement only, each | 38 | $924.57 |
| L8695 | External recharging system for battery (external) for use with implantable neurostimulator, replacement only | 20 | $15.84 |
| L8696 | Antenna (external) for use with implantable diaphragmatic/phrenic nerve stimulation device, replacement, each | 17 | $213.68 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.