L8042 — Orbital prosthesis, provided by a non-physician
L8042 is a HCPCS Level II code for orbital prosthesis, provided by a non-physician. It belongs to the Orthotic and Prosthetic Procedures and Devices section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Medically Unlikely Edits — units per day
The most units of L8042 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- DME supplier
- 2 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for L8042
- Long descriptor
- Orbital prosthesis, provided by a non-physician
- Short descriptor
- Orbital prosthesis
- Added
- January 1, 2001
- BETOS
- D1F
- Pricing indicator
- 38 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Orthotics, prosthetics, prosthetic devices and vision services. Price subject to floors and ceilings.
Codes adjacent to L8042
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If L8042 is not quite right, the correct code is very often within a few positions of it.
- L8030Breast prosthesis, silicone or equal, without integral adhesive
- L8031Breast prosthesis, silicone or equal, with integral adhesive
- L8032Nipple prosthesis, prefabricated, reusable, any type, each
- L8033Nipple prosthesis, custom fabricated, reusable, any material, any type, each
- L8035Custom breast prosthesis, post mastectomy, molded to patient model
- L8039Breast prosthesis, not otherwise specified
- L8040Nasal prosthesis, provided by a non-physician
- L8041Midfacial prosthesis, provided by a non-physician
- L8043Upper facial prosthesis, provided by a non-physician
- L8044Hemi-facial prosthesis, provided by a non-physician
- L8045Auricular prosthesis, provided by a non-physician
- L8046Partial facial prosthesis, provided by a non-physician
- L8047Nasal septal prosthesis, provided by a non-physician
- L8048Unspecified maxillofacial prosthesis, by report, provided by a non-physician
- L8049Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a non-physician
- L8300Truss, single with standard pad
Questions about L8042
What is HCPCS code L8042?
L8042 is a HCPCS Level II code for orbital prosthesis, provided by a non-physician. It sits in the Orthotic and Prosthetic Procedures and Devices section.
Does Medicare cover L8042?
The CMS HCPCS file marks L8042 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.