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HCPCS / L8020
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L8020 Prosthetics & Orthotics 53 States

Breast prosthesis, mastectomy form

Short Desc Mastectomy form
Coverage Alert: Special Coverage Instructions Apply
Added Date
1986-01-01
Effective From
1996-01-01
National Floor
$245.60
National Ceiling
$327.46

Fee Schedule Rates

Effective Jan 2026

Official Medicare DMEPOS pricing for 2026.

State Modifier Non-Rural Rural
AK
Base Rate
$251.18
Same
AL
Base Rate
$279.11
Same
AR
Base Rate
$278.14
Same
AZ
Base Rate
$255.91
Same
CA
Base Rate
$255.91
Same
CO
Base Rate
$245.60
Same
CT
Base Rate
$245.60
Same
DC
Base Rate
$306.30
Same
DE
Base Rate
$306.30
Same
FL
Base Rate
$279.11
Same
GA
Base Rate
$279.11
Same
HI
Base Rate
$268.60
Same
IA
Base Rate
$291.65
Same
ID
Base Rate
$294.95
Same
IL
Base Rate
$278.40
Same
IN
Base Rate
$278.40
Same
KS
Base Rate
$291.65
Same
KY
Base Rate
$279.11
Same
LA
Base Rate
$278.14
Same
MA
Base Rate
$245.60
Same
MD
Base Rate
$306.30
Same
ME
Base Rate
$245.60
Same
MI
Base Rate
$278.40
Same
MN
Base Rate
$278.40
Same
MO
Base Rate
$291.65
Same
MS
Base Rate
$279.11
Same
MT
Base Rate
$245.60
Same
NC
Base Rate
$279.11
Same
ND
Base Rate
$245.60
Same
NE
Base Rate
$291.65
Same
NH
Base Rate
$245.60
Same
NJ
Base Rate
$293.60
Same
NM
Base Rate
$278.14
Same
NV
Base Rate
$255.91
Same
NY
Base Rate
$293.60
Same
OH
Base Rate
$278.40
Same
OK
Base Rate
$278.14
Same
OR
Base Rate
$294.95
Same
PA
Base Rate
$306.30
Same
PR
Base Rate
$366.25
Same
RI
Base Rate
$245.60
Same
SC
Base Rate
$279.11
Same
SD
Base Rate
$245.60
Same
TN
Base Rate
$279.11
Same
TX
Base Rate
$278.14
Same
UT
Base Rate
$245.60
Same
VA
Base Rate
$306.30
Same
VI
Base Rate
$293.60
Same
VT
Base Rate
$245.60
Same
WA
Base Rate
$294.95
Same
WI
Base Rate
$278.40
Same
WV
Base Rate
$306.30
Same
WY
Base Rate
$245.60
Same