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See a sample rate comparisonHCPCS L4000 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.
Replace girdle for spinal orthosis (Cervical-thoracic-lumbar-sacral orthosis (CTLSO) or Shoulder orthosis (SO))
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Orthotic Replacement Parts or Repair |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L4000 |
National average reimbursement for HCPCS L4000 by major payers:
$1,366.91
$847.29
$898.84
$1,864.48
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HCPCS L4000
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$3,149.67Published rateEmory Crawford Long Hospital
Emory University
$2,109.13Published rateQuest Diagnostics Incorporated
$957.27Published rateMichael Koch
Pathology Lab Of Georgia LLC
$716.63Published rateProfessional Resources Management Of Rabun, LLC, Mountain Lakes Medical Center
$638.29Published rate
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See a sample payer proposalHCPCS L4000 vs. Other Orthotic Replacement Parts or Repair Codes
The HCPCS L4000 code is part of the Orthotic Procedures and services services used for Orthotic Replacement Parts or Repair. 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 L4000 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 |
|---|---|---|
| L3999-HCPCS | High | Upper limb orthosis, not otherwise specified |
| L4000-HCPCS | High | Replace girdle for spinal orthosis (Cervical-thoracic-lumbar-sacral orthosis (CTLSO) or Shoulder orthosis (SO)) |
| L4002-HCPCS | Low | Replacement strap, any orthosis, includes all components, any length, any type |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L4000. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L4000 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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