HCPCS L1005 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Orthotic Procedures and services • Scoliosis Orthotic Devices |
| Complexity Level | High |
National average reimbursement for HCPCS L1005 by major payers:
$3,144.54
$2,060.63
$2,271.85
$4,551.47
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS L1005 | ||||||
United | L1005 | $4646.00 | 1104364637 - NICOLE GUTMAN | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Family Nurse Practitioner (363LF0000X) |
United | L1005 | $4646.00 | 1073704441 - DANIEL DAHLE | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | L1005 | $4646.00 | 1497725295 - BRIAN JENKINS | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | General Practice Physician (208D00000X) |
United | L1005 | $4646.00 | 1033523329 - DANIEL LONG | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurology Physician (2084N0400X) |
United | L1005 | $4646.00 | 1588941975 - BILLIE STURGEON | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Nurse Practitioner (363L00000X) |
United | L1005 | $4646.00 | 1033595087 - MARIA JOSEPH | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | L1005 | $4646.00 | 1487604526 - LISA KOKONTIS | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurology Physician (2084N0400X) |
United | L1005 | $4646.00 | 1619070802 - ALEXANDER HAWKINS | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurological Surgery Physician (207T00000X) |
United | L1005 | $4646.00 | 1184956864 - DOUGLAS BARTELT | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Family Nurse Practitioner (363LF0000X) |
United | L1005 | $4646.00 | 1538119649 - PHILIP YAZBAK | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurological Surgery Physician (207T00000X) |
United | L1005 | $4646.00 | 1295284560 - JAIME VELIE | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Family Nurse Practitioner (363LF0000X) |
United | L1005 | $6885.16 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | L1005 | $4646.00 | 1972388189 - CHRISTOPHER WILLIAMS | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Nurse Practitioner (363L00000X) |
United | L1005 | $4646.00 | 1285013953 - LISA TRUTTSCHEL | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Neurology Physical Therapist (2251N0400X) |
United | L1005 | $4646.00 | 1073704441 - DANIEL DAHLE | 391731465 - (WI) NEUROSCIENCE GROUP OF NORTHEAST WISCONSIN, S.C. | WI | Physical Therapist (225100000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS L1005 vs. Other Scoliosis Orthotic Devices Codes
The HCPCS L1005 code is part of the Orthotic Procedures and services services used for Scoliosis Orthotic Devices. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS L1005 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| L1001-HCPCS | High | Cervical-thoracic-lumbar-sacral orthosis (CTLSO), immobilizer, infant size, prefabricated, includes fitting and adjustment |
| L1005-HCPCS | High | Tension based scoliosis orthosis and accessory pads, includes fitting and adjustment |
| L1010-HCPCS | Low | Addition to Cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, axilla sling |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L1005. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L1005 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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