HCPCS Level II › L codes L8613 Ossicular implantOssicula implant
Medicare coverage: Special coverage instructions apply 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 2 units per day (clinical), rationale: Anatomic Consideration DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for L8613 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, prosthetics and orthotics (PO): non-rural $314.80 to $418.46 in the contiguous states; ceiling $419.73, floor $314.80 Payer policies and prior authorization for L8613 Payer coverage policies that name L8613 L8613 appears in 1 coverage policy from Blue Cross & Blue Shield of Mississippi.
Payer Policy Role in policy Reviewed 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 OH, VA.
AZ: $302.90 (dme), effective Oct 1, 2026 CO: $242.98 (chp_plus, non-facility), effective Jul 1, 2026 IN: $348.71 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 MA: $292.68 (orthotics_prosthetics_rates), effective Apr 1, 2024 OH: $289.01 (dme), effective Jan 1, 2026 OK: $257.95 (dme), effective Jan 1, 2026 VA: $282.48 (medical), effective Jan 1, 2012 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 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.