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See a sample rate comparisonHCPCS L5230 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, for proximal femoral focal deficiency, constant friction knee, shin, SACH foot
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Above the Knee Prosthetics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5230 |
National average reimbursement for HCPCS L5230 by major payers:
$4,725.64
$2,710.11
$2,975.96
$6,673.47
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HCPCS L5230
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$8,763.24Published rateQuest Diagnostics Incorporated
$3,064.83Published rateHospital Authority Of Jefferson County And The City Of Louisville, Jefferson Hospital
Hospital Authority Of Jefferson County And The City Of Louisville
$2,302.94Published rateEffingham Hospital, Inc., Effingham Health System
Effingham Hospital Inc
$2,182.81Published rateGood Samaritan Hospital, Inc., St. Mary'S Good Samaritan Hospital
Good Samaritan Hospital Inc
$1,518.58Published rate
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See a sample payer proposalHCPCS L5230 vs. Other Above the Knee Prosthetics Codes
The HCPCS L5230 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 L5230 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 |
|---|---|---|
| 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 |
| L5250-HCPCS | High | Hip disarticulation, Canadian type; molded socket, hip joint, single axis 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 L5230. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5230 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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