HCPCS L3213 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 • Benesch Boots |
| Complexity Level | Low |
National average reimbursement for HCPCS L3213 by major payers:
$47.26
$37.40
$32.64
$61.04
| 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 L3213 | ||||||
United | L3213 | $37.15 | 1417979501 - JEFFERSON KILPATRICK | 455568773 | NC | Facial Plastic Surgery Physician (207YS0123X) |
United | L3213 | $26.27 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $30.89 | 1306896253 - HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA, SOUTH GEORGIA MEDICAL CENTER | 586004467 - (GA) HOSPITAL AUTHORITY OF VALDOSTA AND LOWNDES COUNTY GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $30.96 | 1093753386 - WILLAMETTE COMMUNITY HEALTH SOLUTIONS, CASCADE HEALTH SOLUTIONS | 930421470 | OR | Community Based Hospice Care Agency (251G00000X) |
United | L3213 | $57.51 | 1780694620 - CARSON MEDICAL GROUP PROFESSIONAL CORPORATION | 880133501 - CARSON MEDICAL GROUP | NV | Obstetrics & Gynecology Physician (207V00000X) |
United | L3213 | $46.77 | 1992789721 - PHOEBE PUTNEY MEMORIAL HOSPITAL INC, PHOEBE PUTNEY MEMORIAL HOSPTIAL | 263792403 - PHOEBE PHYSICIAN GROUP INC | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $26.27 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $41.20 | 1689744450 - ARTHUR M. BLANK HOSPITAL, INC., ARTHUR M. BLANK HOSPITAL | 582147112 - (GA) CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | L3213 | $40.77 | 1912099094 - COLQUITT REGIONAL MEDICAL CENTER | 580607088 - COLQUITT REGIONAL MEDICAL CENTER | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $30.81 | 1396770004 - HOSPITAL AUTHORITY OF WASHINGTON COUNTY, WASHINGTON COUNTY REGIONAL MEDICAL CENTER | 586012329 - (GA) HOSPITAL AUTHORITY OF WASHINGTON COUNTY | GA | Rural Acute Care Hospital (282NR1301X) |
United | L3213 | $30.96 | 1093753386 - WILLAMETTE COMMUNITY HEALTH SOLUTIONS, CASCADE HEALTH SOLUTIONS | 930421470 | OR | Community Based Hospice Care Agency (251G00000X) |
United | L3213 | $70.01 | 1255891958 - PIEDMONT NEWTON EKG BILLING LLC | 814475074 - (GA) PIEDMONT NEWTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $18.35 | 1235153883 - WILDWOOD SANITARIUM, INCORPORATED, WILDWOOD LIFESTYLE CENTER AND HOSPITAL | 586039864 - (GA) WILDWOOD SANITARIUM INCORPORATED | GA | General Acute Care Hospital (282N00000X) |
United | L3213 | $40.77 | 1497064679 - JENKINS COUNTY HOSPITAL LLC, OPTIM MEDICAL CENTER - JENKINS | 581158547 - (GA) HOSPITAL AUTHORITY OF JENKINS COUNTY DBA JENKINS COUNTY MEDICAL CENTER | GA | Critical Access Hospital (282NC0060X) |
United | L3213 | $45.88 | 1487684122 - UNION COUNTY HOSPITAL AUTHORITY, UNION GENERAL HOSPITAL | 586025393 - (GA) UNION COUNTY HOSPITAL AUTHORITY | GA | 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 L3213 vs. Other Benesch Boots Codes
The HCPCS L3213 code is part of the Orthotic Procedures and services services used for Benesch Boots. 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 L3213 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 |
|---|---|---|
| L3212-HCPCS | Low | Benesch boot, pair, infant |
| L3213-HCPCS | Low | Benesch boot, pair, child |
| L3214-HCPCS | Low | Benesch boot, pair, junior |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L3213. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L3213 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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