HCPCS L3916 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 • Additional Miscellaneous Orthotics, Upper Extremities |
| Complexity Level | Moderate |
National average reimbursement for HCPCS L3916 by major payers:
$463.96
$321.43
$339.85
$686.39
| 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 L3916 | ||||||
United | L3916 | $298.14 | 1669677019 - JAMES MILLER | 621123296 - (TN) UNIVERSITY ANESTHESIOLOGISTS PLLC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $298.14 | 1124091947 - MARK MURRAY | 621123296 - (TN) UNIVERSITY ANESTHESIOLOGISTS PLLC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $292.38 | 1033503412 - RYAN DAVIDOVICH | 620931432 - (TN) ANESTHESIA MEDICAL GROUP PC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $259.77 | 1508107533 - JAMES E FOX MD PLLC, ACTIVE PAIN TREATMENT | 270045899 - (TN) JAMES E FOX MD PLLC | TN | Pain Clinic/Center (261QP3300X) |
United | L3916 | $298.14 | 1841246774 - GARY MUND | 621854015 - (TN) ANESTHESIA SERVICES OF MIDDLE TENNESSEE PLLC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $292.38 | 1205812682 - NAVDIP RANGI | 621091810 - (TN) PARAGON ANESTHESIA, P.C. | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $298.14 | 1083194237 - SPECTRUM PAIN CLINICS INC. | 621859332 - (TN) SPECTRUM PAIN CLINICS INC | TN | Interventional Pain Medicine Physician (208VP0014X) |
United | L3916 | $292.38 | 1477528693 - SERENA LAU | 30417049 - MEMORIAL HEALTH PARTNERS FOUNDATION INC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $203.40 | 1265039556 - RURAL HEALTH PAIN MANAGEMENT LLC | 844202443 - (TN) RURAL HEALTH PAIN MANAGEMENT LLC | TN | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | L3916 | $292.38 | 1134357718 - ARJUN DALAL | 620931432 - (TN) ANESTHESIA MEDICAL GROUP PC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $292.38 | 1245523117 - MARCOS LOPEZ | 352528741 - VANDERBILT UNIVERSITY MEDICAL CENTER | TN | Critical Care Medicine (Anesthesiology) Physician (207LC0200X) |
United | L3916 | $412.81 | 1972594638 - CLAUDE VACHON | 453072990 - (GA) TIFT REGIONAL HEALTH SYSTEM INC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $292.38 | 1932303757 - COREY CARPENTER | 994984740 - (TN) BRADLEY ANESTHESIA SERVICES PC | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $292.38 | 1437160322 - FERNANDO ABAD | 882051065 | TN | Anesthesiology Physician (207L00000X) |
United | L3916 | $292.38 | 1952307118 - WALLACE FRIEDMAN | 620931432 - (TN) ANESTHESIA MEDICAL GROUP PC | TN | Anesthesiology Physician (207L00000X) |
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 L3916 vs. Other Additional Miscellaneous Orthotics, Upper Extremities Codes
The HCPCS L3916 code is part of the Orthotic Procedures and services services used for Additional Miscellaneous Orthotics, Upper Extremities. 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 L3916 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 |
|---|---|---|
| L3915-HCPCS | Moderate | Wrist hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L3916-HCPCS | Moderate | Wrist hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
| L3917-HCPCS | Low | Hand orthosis (HO), metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L3916. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L3916 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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