Silicone or equivalent external breast form that adheres directly to the skin

This code describes an external breast form made of silicone or a comparable material, designed to adhere directly to the skin. It is used to restore the appearance of a natural breast contour following a mastectomy or other breast-altering surgery. This prosthesis is distinct from those that fit into a bra pocket.

This code is appropriate for billing a patient's purchase of a self-adhesive, silicone-based breast prosthesis. Documentation should clearly indicate the medical necessity for a breast prosthesis, typically following a mastectomy, and specify the type of prosthesis as an adhesive, silicone or equivalent form.

• Ensure documentation specifies an integral adhesive feature; otherwise, a non-adhesive prosthesis code may be more appropriate.
• Do not confuse with codes for non-silicone or non-adhesive breast prostheses (e.g., L8015, L8020).
• Verify payer-specific policies regarding frequency limits and medical necessity criteria for external breast prostheses.