Does L8033 require prior authorization?

Yes, L8033 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`L8033`, Nipple prosthesis, custom fabricated, reusable, any material, any type, each

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted for items addressed by this policy.
For DMEPOS base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO/WOPD before delivering the item to the beneficiary.
For base items requiring a WOPD and separately billed associated items, the WOPD must list the base item (and may list associated items) prior to delivery of any separately billed associated items.

For refills, suppliers must contact the beneficiary (or designee), document an affirmative response prior to dispensing, and make contact no sooner than 30 calendar days prior to the expected end of the current supply.

Key Coverage Criteria

An external breast prosthesis is covered for a patient who has had a mastectomy.
An external breast prosthesis garment with mastectomy form (HCPCS L8015) is covered for use in the postoperative period prior to a permanent prosthesis or as an alternative to a mastectomy bra and breast prosthesis.
A mastectomy bra (HCPCS L8000) is covered when used with a covered mastectomy form (HCPCS L8020) or silicone (or equal) breast prosthesis (HCPCS L8030) and the bra pocket is used to hold the form/prosthesis.
An external breast prosthesis of the same type may be replaced at any time if it is lost or irreparably damaged (excluding ordinary wear and tear).
An external breast prosthesis of a different type may be covered at any time if a change in the patient's medical condition necessitates a different type of item.
Coverage for breast reconstruction and breast prostheses following mastectomy or lumpectomy is governed by federal and/or state mandates.

4 Active Policies

CIGNA-0178, Breast Reconstruction Following Mastectomy or Lumpectomy

HUMANA-PROSTHETICS-KY-MEDICAID, Prosthetics

EVICORE-HPLAN-CIGNA_MEDICARE-268F28B96146, Cigna Medicare Advantage Durable Medical Equipment Code List - Effective 01/01/2025

L33317, External Breast Prostheses

`L8033`, Nipple prosthesis, custom fabricated, reusable, any material, any type, each

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

L8033, Nipple prosthesis, custom fabricated, reusable, any material, any type, each

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`L8033`, Nipple prosthesis, custom fabricated, reusable, any material, any type, each