`L8515` Gel cap app device for trach

Gelatin capsule, application device for use with tracheoesophageal voice prosthesis, each

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (clinical), rationale: Clinical: Data
Outpatient hospital: max 1 units per day (clinical), rationale: Clinical: Data
DME supplier: max 1 units per day (clinical), rationale: Clinical: Data

Medicare pricing for L8515

DMEPOS fee schedule, July 2026 (DME26-C)

no modifier, prosthetics and orthotics (PO): non-rural $75.84 to $78.60 in the contiguous states; $75.84 to $83.45 in AK, HI, PR and VI; ceiling $92.57, floor $69.43

Payer policies and prior authorization for L8515

1 of 1 payer prior-auth lists that name L8515 require prior authorization or set conditions: Rocky Mountain Health Plans.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025

Payer coverage policies that name L8515

L8515 appears in 2 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Voice Prosthesis for Voice Rehabilitation Following Total Laryngectomy (0560)	covered if criteria are met	Aug 26, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Prosthetics (L.1.04.401)	covered if criteria are met		payer document

Medicaid fee-for-service

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

AZ: $70.60 (dme), effective Oct 1, 2026
CO: $60.63 (chp_plus, non-facility), effective Jul 1, 2026
IN: $64.79 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $48.05 (dme), effective Jan 1, 2026
LA: $42.42 (dme), effective Jul 1, 2012
MD: $64.46 (dme), effective Apr 1, 2026
NE: $66.42 (dme), effective Jul 1, 2026
NY: $50.19 (dme), effective Jul 1, 2026
OH: $59.48 (dme), effective Jan 1, 2026
OK: $54.70 (dme), effective Jan 1, 2026
VA: $57.17 (medical), effective Jan 1, 2012
VT: $63.57 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $50.19 (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.

L8515 Gel cap app device for trach