MedicaidCoverageMedium impact
2025.53 - Coverage of Custom Breast Prosthesis
Connecticut Medicaid (HUSKY Health)·CT · Plastic Surgery, Oncology, General Surgery·Provider Bulletin
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid (HUSKY Health) confirms coverage of custom breast prostheses under code L8035 at $2,615.79 without prior authorization. Up to 2 units per date of service are allowed, with additional quantities requiring medical necessity documentation and billing on separate dates.
Action Required
Immediately: Billing team should verify L8035 (custom breast prosthesis) is set up in billing system for Connecticut Medicaid at $2,615.79 rate. Ensure system allows up to 2 units per date of service without prior auth. Configure system to require RT (right side) or LT (left side) modifiers on all L8035 claims. For quantities over 2, bill on separate dates and maintain medical necessity documentation on file.