HCPCS L3967 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Shoulder-elbow-wrist-hand Orthotics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L3967 |
National average reimbursement for HCPCS L3967 by major payers:
$1,841.43
$1,162.93
$1,267.55
$1,829.92
HCPCS L3967 vs. Other Shoulder-elbow-wrist-hand Orthotics Codes
The HCPCS L3967 code is part of the Orthotic Procedures and services services used for Shoulder-elbow-wrist-hand 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 L3967 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 |
|---|---|---|
| L3962-HCPCS | Moderate | Shoulder elbow wrist hand orthosis (SEWHO), abduction positioning, erbs palsey design, prefabricated, includes fitting and adjustment |
| L3967-HCPCS | High | Shoulder elbow wrist hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment |
| L3971-HCPCS | High | Shoulder elbow wrist hand orthosis (SEWHO), shoulder cap design, 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 L3967. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L3967 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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