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HCPCS L3904 Fee Schedule

Last Verified: November 2025

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

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

Preview provider-level rates for...
For billing codeHCPCS L3904
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS L3904

United
L3904$6214.221073502985 - CHU CHEN42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
L3904$2151.441619040284 - QUEST DIAGNOSTICS VENTURE LLC232933949PAClinical Medical Laboratory (291U00000X)
United
L3904$5641.641992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS581537752 - EMORY UNIVERSITYGAGeneral Acute Care Hospital (282N00000X)
United
L3904$1961.211306136551 - UJUKA ILOABUCHI582483738GAWomen's Hospital (282NW0100X)
United
L3904$6637.021598964082 - EMORY HEALTHCARE582030692 - EMORY UNIVERSITYGAGeneral Acute Care Hospital (282N00000X)
United
L3904$4304.521619061769 - ANNA JAQUES HOSPITAL42104338 - (MA) ANNA JAQUES HOSPITALMAPsychiatric Hospital Unit (273R00000X)
United
L3904$1780.781073567038 - PALMYRA PARK HOSPITAL, INC., PALMYRA MEDICAL CENTERS721553462GAGeneral Acute Care Hospital (282N00000X)
United
L3904$1780.781194779702 - JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.580566121 - JOHN D ARCHBOLD MEMORIAL HOSPITAL INCGAGeneral Acute Care Hospital (282N00000X)
United
L3904$1706.921255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN581685139 - (GA) THE MEDICAL CENTER INCGAGeneral Acute Care Hospital (282N00000X)
United
L3904$2151.441932145778 - QUEST DIAGNOSTICS INCORPORATED161387862 - QUEST DIAGNOSTICS INCORPORATEDNJClinical Medical Laboratory (291U00000X)
United
L3904$1610.591356860621 - CHI MEMORIAL HOSPITAL822748395 - CHI MEMORIAL HOSPITAL - GEORGIAGAGeneral Acute Care Hospital (282N00000X)
United
L3904$1780.781962435792 - HOUSTON HOSPITALS INC, HOUSTON MEDICAL CENTER711045290 - (GA) HOUSTON HOSPITALS INCGAGeneral Acute Care Hospital (282N00000X)
United
L3904$2151.441881630614 - QUEST DIAGNOSTICS LLC IL364257926ILClinical Medical Laboratory (291U00000X)
United
L3904$2969.631023055126 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR CENTENNIAL MEDICAL CENTER710897031TNGeneral Acute Care Hospital (282N00000X)
United
L3904$4304.521992779482 - ANNA JAQUES HOSPITAL42104338 - (MA) ANNA JAQUES HOSPITALMAGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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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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