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See a sample rate comparisonHCPCS L5220 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.
Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Above the Knee Prosthetics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5220 |
National average reimbursement for HCPCS L5220 by major payers:
$3,300.95
$1,969.72
$2,191.50
$4,521.56
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HCPCS L5220
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$6,215.87Published ratePhoebe Worth Medical Center, Inc, Phoebe Worth Medical Center, Inc
Phoebe Worth Medical Center Inc
$2,487.90Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
Quest Diagnostics Clinical Laboratories, Inc.
$2,303.30Published rateMichael Guillette
Aztec Urgent Care LLC
$1,527.05Published rateJenkins County Hospital LLC, Optim Medical Center - Jenkins
$1,437.81Published rate
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See a sample payer proposalHCPCS L5220 vs. Other Above the Knee Prosthetics Codes
The HCPCS L5220 code is part of the Prosthetic Procedures services used for Above 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 L5220 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 |
|---|---|---|
| L5210-HCPCS | High | Above knee, short prosthesis, no knee joint ('stubbies'), with foot blocks, no ankle joints, each |
| L5220-HCPCS | High | Above knee, short prosthesis, no knee joint ('stubbies'), with articulated ankle/foot, dynamically aligned, each |
| L5230-HCPCS | High | Above knee, for proximal femoral focal deficiency, constant friction knee, shin, 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 L5220. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5220 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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