Skip to Main Content
 
 
 
Web Content Viewer

Policy Education Topics

Web Content Viewer
Web Content Viewer

Mastectomy Bra Billing Issues

National Government Services, the Jurisdiction B DME MAC, has received several questions regarding mastectomy bras and upgrading. The long narrative description for HCPCS L8000–L8002 indicates that the bra may be constructed of any material (e.g., cotton, polyester or other materials), with any type or location of closure, any size, with or without integrated structural support (e.g., underwire). L8015 describes a camisole-type undergarment with polyester fill used post mastectomy.

Upgrade billing is not permitted for mastectomy bras (L8000–L8002, L8015), despite any characteristics, features, or prices involved. Suppliers who bill claims for mastectomy bras as an upgrade will have claims returned as unprocessable with ANSI 4 due to incorrect modifier. Claims returned as unprocessable will need to be corrected by the supplier and resubmitted.

Suppliers who have chosen to be nonparticipating suppliers may bill the claim as nonassigned in order for the beneficiary to cover the difference in price.

Please refer to the external breast prostheses local coverage determination and policy article located on the National Government Services Web site.

Mastectomy Bra Billing Issues
Web Content Viewer
Web Content Viewer
Complementary Content