`L8465` Shrinker upper limb

Prosthetic shrinker, upper limb, each

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 4 units per day (clinical), rationale: Clinical: Data
DME supplier: max 4 units per day (clinical), rationale: Clinical: Data

Medicare pricing for L8465

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, prosthetics and orthotics (PO): non-rural $59.71 to $79.62 in the contiguous states; $38.70 to $59.71 in AK, HI, PR and VI; ceiling $79.62, floor $59.71

Payer policies and prior authorization for L8465

Payer coverage policies that name L8465

L8465 appears in 17 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Upper Limb Prostheses (0399)	covered if criteria are met	Jul 16, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Prosthetics (L.1.04.401)	covered if criteria are met		payer document
Capital Blue Cross	Upper Limb Prostheses (MP 6.052) Procedure codes	covered if criteria are met	Apr 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Lower-Limb Prosthetics, Including Microprocessor-Controlled Prosthetics (DME104.012) HCPCS Codes L2221, L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160,	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	State-Specific Criteria (CS360IN.03) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (2026T0641I) Upper Limb Prosthetics	listed, no stance	Apr 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (CS360.E) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Idaho Only) (CS360ID.D) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Kansas Only) (CS360KS.03) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Kentucky Only) (CS360KY.05)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Nebraska Only) (CS360NE.E) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for New Jersey Only) (CS360NJ.E) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for New Mexico Only) (CS360NM.D) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for North Carolina Only) (CSNCT0641.04)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Ohio Only) (CS360OH.F) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Pennsylvania Only) (CS360PA.E)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Upper Extremity Prosthetic Devices (for Tennessee Only) (CS360TN.E) Upper Limb Prosthetics	listed, no stance	Jun 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in LA, MA, MS, NY, OH, VA, WV.

AZ: $55.58 (dme), effective Oct 1, 2026
CO: $40.97 (chp_plus, non-facility), effective Jul 1, 2026
FL: $37.99 (dme), effective Jul 1, 2026
IL: $42.68 (dme), effective Jan 1, 2026
IN: $62.84 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KS: $35.83 (default, Mid Level Practitioner), effective Jul 1, 2026
KY: $49.75 (dme), effective Jan 1, 2026
LA: $36.39 (dme), effective Jul 1, 2012
MA: $55.04 (orthotics_prosthetics_rates), effective Apr 1, 2024
MD: $61.40 (dme), effective Apr 1, 2026
MS: $63.70 (comprehensive), effective Jul 1, 2026
ND: $68.54 (dme), effective Aug 1, 2026
NE: $51.27 (dme), effective Jul 1, 2026
NY: $25.25 (dme), effective Jul 1, 2026
OH: $39.22 (dme), effective Jan 1, 2010
OK: $46.93 (dme), effective Jan 1, 2026
TX: $37.20 (dmepos_tos_9_e_j_l_and_r, Medical Supplier (Dme), non-facility), effective Apr 1, 1992
VA: $30.00 (medical), effective Jul 1, 1989
VT: $52.59 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $44.88 (prosthetics_orthotics), effective Jul 1, 2026
WY: $40.85 (professional), effective Jan 1, 2021

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

L8465 Shrinker upper limb