Does L8035 require prior authorization?

No, L8035 does not require prior authorization (high confidence). Covered without prior authorization.

`L8035`, Custom breast prosthesis, post mastectomy, molded to patient model

HCPCS/CPT

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Suppliers are required to maintain proof of delivery (POD) documentation in their files and provide POD to the Medicare contractor upon request.

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.
Covered ICD-10 diagnoses (listed as covered if selection criteria are met): D05.01 - D05.99 (Carcinoma in situ of breast)

CIGNA-0178, Breast Reconstruction Following Mastectomy or Lumpectomy

L33317, External Breast Prostheses

AETNA-CPB-0097, External Breast Prosthesis

AMBETTER-CP.MP.107, Durable Medical Equipment and Orthotics and Prosthetics Guidelines

Ask Backwork about documentation requirements, denial risks, or coverage in your state.