HCPCS L4360 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Orthotic Procedures and services • Other Lower Extremity Orthotics |
| Complexity Level | Moderate |
National average reimbursement for HCPCS L4360 by major payers:
$268.45
$183.11
$218.71
$367.70
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS L4360 | ||||||
United | L4360 | $107.63 | 1750891974 - ABIGAIL HALL | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Medical Physician Assistant (363AM0700X) |
United | L4360 | $308.02 | 1649289430 - MARCY GAMBINO | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Medical Physician Assistant (363AM0700X) |
United | L4360 | $200.22 | 1578874459 - ELAINE TSUKAYAMA | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Pediatrics Physician (208000000X) |
United | L4360 | $308.02 | 1326764358 - JESSICA BRUTSKY | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Medical Physician Assistant (363AM0700X) |
United | L4360 | $200.22 | 1982043386 - AILEEN CALLAN | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | L4360 | $107.63 | 1992793137 - KAREN FLICK | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Nurse Practitioner (363L00000X) |
United | L4360 | $107.63 | 1548256399 - NIRANJAN SELVARAJAH | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Medicine Physician (207Q00000X) |
United | L4360 | $308.02 | 1356826598 - TIMOTHY BAKER | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Physician Assistant (363A00000X) |
United | L4360 | $308.02 | 1285625996 - SLOCUM DICKSON MEDICAL GROUP PLLC | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Clinic/Center (261Q00000X) |
United | L4360 | $200.22 | 1497098792 - CHRISTOPHER POWERS | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | L4360 | $200.22 | 1447543673 - WILLIAM GAETANO | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Medicine Physician (207Q00000X) |
United | L4360 | $107.63 | 1497534705 - MICHELLE PALUMBO | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | L4360 | $107.63 | 1629738422 - KASSANDRA GIGLIO | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | L4360 | $107.63 | 1003543711 - AMELA THOMPSON | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Family Nurse Practitioner (363LF0000X) |
United | L4360 | $200.22 | 1255318861 - MARK AINSWORTH | 200362623 - SLOCUM DICKSON MEDICAL GROUP PLLC | NY | Optometrist (152W00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS L4360 vs. Other Other Lower Extremity Orthotics Codes
The HCPCS L4360 code is part of the Orthotic Procedures and services services used for Other Lower Extremity 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 L4360 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 |
|---|---|---|
| L4350-HCPCS | Low | Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
| L4360-HCPCS | Moderate | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L4361-HCPCS | Moderate | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L4360. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L4360 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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