Post-mastectomy products are covered by Medicare and other private insurance. Please consult with your insurance provider for detailed, specific information regarding reimbursement.

View the latest information regarding Medicare billings codes. Then click on the current zip file listed. Be patient. The schedule is a large spreadsheet and will take time to download. When it does appear on the screen, you will want to scroll down the page to locate the L8000 codes. The L8000 codes are the HCPCS codes dealing with mastectomy products.

For DMEPOS services, Medicare is divided into four jurisdictions. Each jurisdiction is administered by a DME MAC or Durable Medical Equipment Medicare Administrative Contractors. The MAC is your interface for any questions or concerns you have. Meanwhile, with a Medicare provider number, you may file for reimbursement for products listed in the fee schedule for any Medicare recipient.

Bras are billed under the L8000 code. Non-silicone breast forms are billed under the L8020 code. Silicone breast forms, including silicone partials or shells, are billed under L8030.

The links below are provided as a service to American Breast Care retailers. Please visit the links below on a frequent, regular basis to keep you to up to date. Medicare Policies change often.

Please direct all questions regarding billing and policy to your DME MAC as ABC cannot interpret Medicare policy.

Click here to visit the Medicare Pricing, Data Analysis and Coding (PDAC) website for Healthcare Common Procedure Coding System (HCPCS) coding verification. Visit this site to identify the proper billing code for a DMEPOS item.

Your DME MAC is a valuable tool and resource. Please visit your DME MAC’s website for Medical policies (LCDs), policy articles, fee schedules, Medicare Supplier Manual and forms. Be sure to review and download the “Local Coverage Determination (LCD) for External Breast Prostheses” and the “Local Coverage Article for External Breast Prostheses”. Remember to sign up for your DME MAC’s listserv/newsletter to keep you informed.

Click here for the Jurisdiction A DME MAC, NHIC, Corp., which services Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington DC.

Click here for the Jurisdiction B DME MAC, National Government Services, which serves Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin.

Click here for the Jurisdiction C DME MAC, CGS Administrators, LLC, which services Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, and West Virginia.

Click here for the Jurisdiction D DME MAC, Noridian Administrative Services, which services Alaska, Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, American Samoa, Guam, Mariana Islands

Click here for the Centers for Medicare & Medicaid Services website for DMEPOS related sites.