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HCPCS L3904 Fee Schedule

Last Verified: September 2026

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.

Wrist hand finger orthosis (WHFO), external powered, electric, custom-fabricated
Key FactDetail
Service Type

Orthotic Procedures and services

Wrist-hand-finger Orthotics

Complexity LevelHigh
Medicaid Fee ScheduleView Medicaid rates for L3904

National average reimbursement for HCPCS L3904 by major payers:

bcbs

$3,039.11

uhc

$1,933.94

aetna

$2,115.97

cigna

$4,328.38

Compare published rates across providers.

Choose a payer to see a sample of rates for HCPCS L3904.

HCPCS L3904
5 of 25 sample ratesHigher to lower in this preview
  1. Emory Crawford Long Hospital

    Emory University

    GAGeneral Acute Care HospitalNPI 1225281603Tax ID 58-2030692

    $6,637.02Published rate
  2. Hca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center

    Quest Diagnostics Clinical Laboratories, Inc.

    TNGeneral Acute Care HospitalNPI 1023055126Tax ID 38-2084239

    $2,969.63Published rate
  3. Unilab Corporation, Quest Diagnostics Clinical Lab

    CAClinical Medical LaboratoryNPI 1366479099Tax ID 71-0897031

    $2,151.44Published rate
  4. Effingham Hospital, Inc., Effingham Health System

    Effingham Hospital Inc

    GACritical Access HospitalNPI 1811962756Tax ID 47-4393589

    $1,879.35Published rate
  5. Paulding Medical Center, Inc., Wellstar Paulding Hospital

    Paulding Medical Center Inc

    GAGeneral Acute Care HospitalNPI 1457329435Tax ID 58-2095884

    $1,707.35Published rate

National sample. Rates vary by location, specialty, and contract.

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HCPCS L3904 vs. Other Wrist-hand-finger Orthotics Codes

The HCPCS L3904 code is part of the Orthotic Procedures and services services used for Wrist-hand-finger 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 L3904 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.

CodeComplexityDescription
L3901-HCPCSHighWrist hand finger orthosis (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom-fabricated
L3904-HCPCSHighWrist hand finger orthosis (WHFO), external powered, electric, custom-fabricated
L3905-HCPCSModerateWrist hand orthosis (WHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L3904. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the L3904 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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