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See a sample rate comparisonHCPCS L4100 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 leather cuff KAFO, proximal thigh
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Orthotic Replacement Parts or Repair |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for L4100 |
National average reimbursement for HCPCS L4100 by major payers:
$116.27
$70.70
$75.28
$144.28
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HCPCS L4100
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$243.28Published rateChu Chen
$129.86Published rateUnilab Corporation, Quest Diagnostics Clinical Lab
$79.73Published rateHospital Authority Of Liberty County, Liberty Regional Medical Center
$57.47Published rateTy Cobb Healthcare System, Cobb Memorial Hospital
Community Services Group Inc
$52.20Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L4100 vs. Other Orthotic Replacement Parts or Repair Codes
The HCPCS L4100 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 L4100 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 |
|---|---|---|
| L4090-HCPCS | Low | Replace metal bands KAFO-AFO, calf or distal thigh |
| L4100-HCPCS | Low | Replace leather cuff KAFO, proximal thigh |
| L4110-HCPCS | Low | Replace leather cuff KAFO-AFO, calf or distal thigh |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L4100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L4100 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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