HCPCS L1843 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Orthotic Procedures and services • Knee Orthotics |
| Complexity Level | Moderate |
National average reimbursement for HCPCS L1843 by major payers:
$851.05
$577.71
$661.51
$1,280.33
| 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 L1843 | ||||||
United | L1843 | $516.01 | 1326041542 - ALLEN TAFEL | 651011457 - (FL) ORTHOPEDIC SPECIALISTS OF SW FLORIDA PA | FL | Pain Medicine (Physical Medicine & Rehabilitation) Physician (2081P2900X) |
United | L1843 | $849.09 | 1275506115 - SPRINGHILL MEDICAL SERVICES, INC., SPRINGHILL MEDICAL CENTER | 721479692 - SPRINGHILL MEDICAL SERVICES INC | LA | General Acute Care Hospital (282N00000X) |
United | L1843 | $504.44 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | L1843 | $481.80 | 1679845531 - DANA HEMSTREET | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Family Nurse Practitioner (363LF0000X) |
United | L1843 | $504.44 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | L1843 | $516.01 | 1942327366 - CAROLINE SALEEBY | 651011457 - (FL) ORTHOPEDIC SPECIALISTS OF SW FLORIDA PA | FL | Surgical Physician Assistant (363AS0400X) |
United | L1843 | $516.01 | 1104669555 - KYLE SELLERS | 651011457 - (FL) ORTHOPEDIC SPECIALISTS OF SW FLORIDA PA | FL | Physical Therapist (225100000X) |
United | L1843 | $481.80 | 1952557498 - JEREMY KELLEY | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Family Nurse Practitioner (363LF0000X) |
United | L1843 | $516.01 | 1407564610 - SAMANTHA ROCKENHAUS | 651011457 - (FL) ORTHOPEDIC SPECIALISTS OF SW FLORIDA PA | FL | Nurse Practitioner (363L00000X) |
United | L1843 | $570.28 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | L1843 | $1257.50 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | L1843 | $1287.68 | 1821465576 - LAKE SURGICAL HOSPITAL SLIDELL, LLC, SOUTHERN SURGICAL HOSPITAL | 474228147 - (LA) LAKE SURGICAL HOSPITAL SLIDELL, LLC DBA SOUTHERN SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | L1843 | $487.45 | 1063490845 - KEVIN SCHLESSEL | 311425166 | OH | Rheumatology Physician (207RR0500X) |
United | L1843 | $504.44 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | L1843 | $849.09 | 1124170691 - WILLIS KNIGHTON MEDICAL CENTER, INC., WILLIS KNIGHTON SOUTH HOSPITAL | 720400933 - (LA) WILLIS-KNIGHTON MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
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 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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