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PAYER POLICY CHANGES

L8039 Insurance Policy Changes

HCPCS L8039 is officially defined as "Breast prosthesis, not otherwise specified." HCPCS L8039 is referenced in 3 tracked payer policy changes from Blue Shield of California, Sentara Health Plans, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS L8039 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules12
Payers requiring prior auth12
  • Blue Shield of California · Effective November 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield Medicare

  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

    Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for L8039?

Ambetter lists L8039 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for L8039?

AmeriHealth Caritas lists L8039 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for L8039?

Arizona Complete Health lists L8039 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for L8039?

BCBS Michigan lists L8039 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does Blue Shield of California require prior authorization for L8039?

Blue Shield of California lists L8039 on Prior Authorization List for Blue Shield of California for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS L8039?

There are 3 tracked policy changes affecting HCPCS L8039, including updates from Blue Shield of California, Sentara Health Plans, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS L8039?

Payers that have issued tracked updates for HCPCS L8039 include: Blue Shield of California, Sentara Health Plans, Aetna.

How do I get notified when HCPCS L8039 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS L8039. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS L8039?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for L8039

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for L8039 in one place.

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