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See a sample rate comparisonHCPCS L5100 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Below knee, molded socket, shin, SACH foot
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Below the Knee Prosthetics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5100 |
National average reimbursement for HCPCS L5100 by major payers:
$2,736.28
$1,677.76
$1,852.17
$3,837.90
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HCPCS L5100
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$6,133.51Published ratePhoebe Putney Memorial Hospital Inc, Phoebe Putney Memorial Hosptial
Phoebe Physician Group Inc
$2,170.59Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
Quest Diagnostics Clinical Laboratories, Inc.
$1,440.00Published ratePiedmont Newton Ekg Billing LLC
Piedmont Newton Hospital Inc
$1,332.28Published rateChristopher Raio
St Joseph Hospital
$1,011.72Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L5100 vs. Other Below the Knee Prosthetics Codes
The HCPCS L5100 code is part of the Prosthetic Procedures services used for Below the Knee Prosthetics. 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 L5100 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 |
|---|---|---|
| L5060-HCPCS | High | Ankle, Symes, metal frame, molded leather socket, articulated ankle/foot |
| L5100-HCPCS | High | Below knee, molded socket, shin, SACH foot |
| L5105-HCPCS | High | Below knee, plastic socket, joints and thigh lacer, SACH foot |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5100 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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