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See a sample rate comparisonHCPCS L4040 Fee Schedule
Last Verified: September 2026
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.
Replace molded thigh lacer, for custom fabricated orthosis only
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Orthotic Replacement Parts or Repair |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L4040 |
National average reimbursement for HCPCS L4040 by major payers:
$462.35
$271.32
$297.13
$593.81
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HCPCS L4040
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$921.01Published rateUnilab Corporation, Quest Diagnostics Clinical Lab
$306.45Published rateDodge County Hospital Authority, Dodge County Hospital
Dodge County Hospital Authority
$229.41Published rateNavicent Health Oconee, LLC, Navicent Health Baldwin
Navicent Health Oconee LLC
$208.32Published rateGood Samaritan Hospital, Inc., St. Mary'S Good Samaritan Hospital
Good Samaritan Hospital Inc
$152.94Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L4040 vs. Other Orthotic Replacement Parts or Repair Codes
The HCPCS L4040 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 L4040 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 |
|---|---|---|
| L4030-HCPCS | Moderate | Replace quadrilateral socket brim, custom fitted |
| L4040-HCPCS | Moderate | Replace molded thigh lacer, for custom fabricated orthosis only |
| L4045-HCPCS | Moderate | Replace non-molded thigh lacer, for custom fabricated orthosis only |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L4040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L4040 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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