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See a sample rate comparisonHCPCS L5331 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, endoskeletal system, hip joint, single axis knee, SACH foot
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Prosthetics, Lower Limbs |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5331 |
National average reimbursement for HCPCS L5331 by major payers:
$5,692.70
$3,345.16
$3,754.63
$7,463.43
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HCPCS L5331
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$10,807.17Published rateUnion County Hospital Authority, Union General Hospital
Union County Hospital Authority
$5,070.25Published rateHospital Authority Of Candler County, Candler County Hospital
$2,915.16Published rateRedmond Park Hospital LLC, Redmond Hospital Based Services LLC
Redmond Park Hospital LLC
$2,762.26Published rateChristopher Raio
Mercy Medical Center
$2,506.36Published rate
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See a sample payer proposalHCPCS L5331 vs. Other Endoskeletal Prosthetics, Lower Limbs Codes
The HCPCS L5331 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 L5331 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 |
|---|---|---|
| L5321-HCPCS | High | Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee |
| L5331-HCPCS | High | Hip disarticulation, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, SACH foot |
| L5341-HCPCS | High | Hemipelvectomy, Canadian type, molded socket, endoskeletal system, hip joint, single axis knee, 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 L5331. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5331 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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