The 2023 DMEPOS Fee Schedule has been released. It contains one of the largest increases in recent years. If you are interested in reading the full narrative, please review the CMS publication MM 13006, which explains the CY 2023 Updates and calculations in detail.
2023 DMEPOS Fee Schedule Update Factor
The CY2023 Fees have been updated by a factor of 8.7%
CMS pays for certain DMEPOS products and surgical dressings on a fee schedule basis based on Sections 1834(a), (h), and (i) of the Social Security Act.
Available on the Jurisdiction A, B, C, and D – DME MAC websites or for members on AABCP.org, the update includes:
- The fee schedule amounts for new and existing codes
- Payment policy changes
There are no new codes that apply to mastectomy fitters.
Current Mastectomy Billing Codes
- L 8000
- L 8015
- L 8020
- L 8030
- L 8031
- L 8032
- L 8033
- L 8035
- L 8039
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AABCP FAQs – Mastectomy Billing
How many mastectomy bras can be billed?
The number of pocketed mastectomy bras (L8000) that can be billed at a given time depends on the insurance carrier and type of coverage. However, Medicare allows for as many mastectomy bras as are medically necessary.
What mastectomy product does the code L8000 describe?
L8000 describes a pocketed bra where the pocket is used to hold an external breast prosthesis.
What mastectomy product does the code L8001 describe?
L8001 describes a pocketed mastectomy bra with an integrated breast prosthesis on one side (RT or LT).
What mastectomy product does the code L8002 describe?
L8002 describes a pocketed mastectomy bra with integrated breast prostheses on both sides (RT and LT).
What mastectomy product does the code L8015 describe?
L8015 describes a post-surgical garment for use after a mastectomy with a post-surgical style prosthesis, usually referred to as an unweighted ‘puff.’ The garment is to be used in the period after surgery for healing; before a permanent prosthesis is provided. And L8015 is also referred to as a post-surgical camisole or compression garment.
What mastectomy product does the code L8020 describe?
L8020 describes a non-silicone breast prosthesis.
What mastectomy product does the code L8030 describe?
L8030 describes a silicone breast prosthesis with no integral adhesive.
What mastectomy product does the code L8031 describe?
L8031 describes a silicone breast prosthesis with an integral adhesive.
What mastectomy product does the code L8032 describe?
L8032 describes a prefabricated, reusable Nipple Prosthesis made from any material.
What mastectomy product does the code L8033 describe?
L8033 describes a custom-fabricated, reusable Nipple Prosthesis made from any material.
What mastectomy product does the code L8035 describe?
L8035 describes a Custom Breast Prosthesis molded to an individual patient, made from any material.
What mastectomy product does the code L8039 describe?
L8039 describes a billing code for all items and services that do not have a designated code.