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See a sample rate comparisonHCPCS L5250 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.
Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Hip Disarticulation Prosthetics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5250 |
National average reimbursement for HCPCS L5250 by major payers:
$6,039.43
$3,673.15
$3,978.83
$7,980.52
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HCPCS L5250
5 of 25 sample ratesHigher to lower in this preview
Emory Crawford Long Hospital
Emory University
$8,937.09Published rateQuest Diagnostics Venture LLC
$4,397.50Published rateUnilab Corporation, Quest Diagnostics Clinical Lab
$4,150.10Published rateJohn D. Archbold Memorial Hospital, Inc.
John D Archbold Memorial Hospital Inc
$2,820.98Published ratePatrick Reidy
Florida Gulf Coast Ear, Nose And Throat, LLC
$2,674.30Published rate
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See a sample payer proposalHCPCS L5250 vs. Other Hip Disarticulation Prosthetics Codes
The HCPCS L5250 code is part of the Prosthetic Procedures services used for Hip Disarticulation 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 L5250 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 |
|---|---|---|
| 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 |
| L5270-HCPCS | High | Hip disarticulation, tilt table type; molded socket, locking 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 L5250. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5250 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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