HCPCS Code L8010

Official Description

Breast prosthesis, mastectomy sleeve

Short Descr	Mastectomy sleeve
Coverage	Special coverage instructions apply
Pricing Indicator(s)	00 – Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
MPI	9 – Not applicable, as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
MCM	2130 A
BETOS	D1F – Prosthetic/Orthotic devices
TOS Code(s)	P – Lump sum purchase of DME, prosthetics, orthotics
Added Date	1/1/1986
APC Status Indicator	Service Paid under Fee Schedule or Payment System other than OPPS
MUE	0
MUE	0
IOM	100-02, 15, 120
OTS Orthotic	No
CCS Clinical Classification	243 - DME and supplies

GY	Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
RT	Right side (used to identify procedures performed on the right side of the body)
LT	Left side (used to identify procedures performed on the left side of the body)
GA	Waiver of liability statement issued as required by payer policy, individual case
CR	Catastrophe/disaster related
32	Mandated services: services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure.
50	Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
GK	Reasonable and necessary item/service associated with a ga or gz modifier
GP	Services delivered under an outpatient physical therapy plan of care
GZ	Item or service expected to be denied as not reasonable and necessary
KX	Requirements specified in the medical policy have been met