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See a sample rate comparisonHCPCS L4130 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 pretibial shell
| Key Fact | Detail |
|---|---|
| Service Type | Orthotic Procedures and services Orthotic Replacement Parts or Repair |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L4130 |
National average reimbursement for HCPCS L4130 by major payers:
$560.12
$331.50
$368.32
$684.99
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HCPCS L4130
5 of 25 sample ratesHigher to lower in this preview
Anna Jaques Hospital
$745.25Published rateScottish Rite Childrens Medical Ctr, Children'S Healthcare Of Atlanta At Scottish Rite
Childrens Healthcare Of Atlanta Inc
$437.38Published rateUjuka Iloabuchi
Atlanta Womens Health Group, P.C.
$328.04Published rateRedmond Park Hospital LLC, Redmond Hospital Based Services LLC
Redmond Park Hospital LLC
$297.85Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$270.38Published rate
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See a sample payer proposalHCPCS L4130 vs. Other Orthotic Replacement Parts or Repair Codes
The HCPCS L4130 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 L4130 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 |
|---|---|---|
| L4110-HCPCS | Low | Replace leather cuff KAFO-AFO, calf or distal thigh |
| L4130-HCPCS | Moderate | Replace pretibial shell |
| L4205-HCPCS | Low | Repair of orthotic device, labor component, per 15 minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L4130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L4130 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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