HCPCS L4397 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 | Low |
National average reimbursement for HCPCS L4397 by major payers:
$159.33
$111.76
$128.49
$242.25
| 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 L4397 | ||||||
United | L4397 | $111.40 | 1417979501 - JEFFERSON KILPATRICK | 455568773 | NC | Facial Plastic Surgery Physician (207YS0123X) |
United | L4397 | $89.94 | 1417979501 - JEFFERSON KILPATRICK | 560942061 - (NC) PINEHURST SURGICAL CLINIC, P.A. | NC | Facial Plastic Surgery Physician (207YS0123X) |
United | L4397 | $89.94 | 1417979501 - JEFFERSON KILPATRICK | 560942061 - (NC) PINEHURST SURGICAL CLINIC, P.A. | NC | Facial Plastic Surgery Physician (207YS0123X) |
United | L4397 | $111.40 | 1417979501 - JEFFERSON KILPATRICK | 455568773 | NC | Facial Plastic Surgery Physician (207YS0123X) |
United | L4397 | $101.44 | 1144584376 - FORREST POWERS | 620931432 - (TN) ANESTHESIA MEDICAL GROUP PC | TN | Anesthesiology Physician (207L00000X) |
United | L4397 | $96.80 | 1730576372 - CHAD GREENE | 920156177 - (AK) DENALI ANESTHESIA LLC | TN | Anesthesiology Physician (207L00000X) |
United | L4397 | $103.44 | 1427297365 - SPINAL PAIN RELIEF CENTER, P.C. | 264138403 - (TN) SPINAL PAIN RELIEF CENTER PC | TN | Pain Medicine Physician (208VP0000X) |
United | L4397 | $102.97 | 1972584621 - JOHN GALDUN | 851035186 - (VA) DOGWOOD ANESTHESIA PROVIDERS LLC | TN | Anesthesiology Physician (207L00000X) |
United | L4397 | $59.97 | 1114342813 - CENTER FOR SPINE JOINT AND NEUROMUSCULAR REHAB PC | 43636559 - (TN) CENTER FOR SPINE JOINT NEUROMUSCULAR REHABILITATION P.C. | TN | Pain Medicine (Physical Medicine & Rehabilitation) Physician (2081P2900X) |
United | L4397 | $101.44 | 1891951570 - MARY DIMICELI-ZSIGMOND | 620931432 - (TN) ANESTHESIA MEDICAL GROUP PC | TN | Anesthesiology Physician (207L00000X) |
United | L4397 | $96.92 | 1043309271 - CARDIAC ANESTHESIA GROUP | 621505831 - (TN) CARDIAC ANESTHESIA GROUP | TN | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | L4397 | $159.13 | 1477057214 - JAMES BUCK | 223849199 - WAKE FOREST UNIVERSITY HEALTH SCIENCES | TN | Anesthesiology Physician (207L00000X) |
United | L4397 | $95.48 | 1982674164 - BENJAMIN JOHNSON | 621679499 | TN | Pain Medicine (Anesthesiology) Physician (207LP2900X) |
United | L4397 | $101.44 | 1962797258 - CHRISTIANA ROUSSIS | 620931432 - (TN) ANESTHESIA MEDICAL GROUP PC | TN | Anesthesiology Physician (207L00000X) |
United | L4397 | $200.72 | 1063741163 - AZTEC URGENT CARE, LLC | 271495988 - (NM) AZTEC URGENT CARE LLC | NM | Urgent Care Clinic/Center (261QU0200X) |
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 L4397 vs. Other Other Lower Extremity Orthotics Codes
The HCPCS L4397 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 L4397 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 |
|---|---|---|
| L4396-HCPCS | Low | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L4397-HCPCS | Low | Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
| L4398-HCPCS | Low | Foot drop splint, recumbent positioning device, 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 L4397. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L4397 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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