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See a sample rate comparisonHCPCS L1843 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Knee Orthotics |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | $914.775 median of the 8 states in the free preview · View Medicaid rates for L1843 |
National average reimbursement for HCPCS L1843 by major payers:
$851.05
$577.71
$661.51
$1,280.33
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HCPCS L1843
5 of 25 sample ratesHigher to lower in this preview
Lake Surgical Hospital Slidell, LLC, Southern Surgical Hospital
Lake Surgical Hospital Slidell, LLC Dba Southern Surgical Hospital
$1,287.68Published rateWillis Knighton Medical Center, Inc., Willis Knighton South Hospital
Willis-Knighton Medical Center
$869.46Published rateChristopher Raio
St Francis Hospital
$570.28Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$504.44Published rateBama Heart Doc, P.C., Alabama Heart And Vascular Medicine
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$481.80Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L1843 vs. Other Knee Orthotics Codes
The HCPCS L1843 code is part of the Orthotic Procedures and services services used for Knee Orthotics. 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 L1843 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 |
|---|---|---|
| L1840-HCPCS | Moderate | Knee orthosis (KO), derotation, medial-lateral, anterior cruciate ligament, custom fabricated |
| L1843-HCPCS | Moderate | Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L1844-HCPCS | High | Knee orthosis (KO), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L1843. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L1843 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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