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See a sample rate comparisonHCPCS L5280 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.
Hemipelvectomy, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Prosthetics, Lower Limbs |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5280 |
National average reimbursement for HCPCS L5280 by major payers:
$6,286.12
$3,653.69
$4,111.65
$8,615.38
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HCPCS L5280
5 of 25 sample ratesHigher to lower in this preview
Emory Crawford Long Hospital
Emory University
$10,387.11Published rateQuest Diagnostics LLC Il
$4,930.41Published rateProgressive Emergency Physicians PLLC
$3,143.02Published rateAlicia Encinas
Miguel A Arenas Md PC
$3,048.83Published rateGrady Memorial Hospital Corporation, Grady Health Systems
Grady Memorial Hospital Corporation
$2,608.96Published rate
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See a sample payer proposalHCPCS L5280 vs. Other Endoskeletal Prosthetics, Lower Limbs Codes
The HCPCS L5280 code is part of the Prosthetic Procedures services used for Endoskeletal Prosthetics, Lower Limbs. 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 L5280 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 |
|---|---|---|
| L5270-HCPCS | High | Hip disarticulation, tilt table type; molded socket, locking hip joint, single axis constant friction knee, shin, SACH foot |
| L5280-HCPCS | High | Hemipelvectomy, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot |
| L5301-HCPCS | High | Below knee, molded socket, shin, SACH foot, endoskeletal system |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5280. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5280 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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