Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS L5430 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and suspension, 'AK' or knee disarticulation, each additional cast change and realignment
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Prosthetic Fitting, Immediate Postsurgical or Early, Lower Limbs |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5430 |
National average reimbursement for HCPCS L5430 by major payers:
$533.04
$376.04
$409.75
$780.18
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS L5430.
HCPCS L5430
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,155.95Published ratePhoebe Putney Memorial Hospital Inc, Phoebe Putney Memorial Hosptial
Phoebe Physician Group Inc
$453.89Published rateQuest Diagnostics Incorporated
$338.83Published rateHospital Authority Of Ben Hill, Dorminy Medical Center
$273.58Published rateChristopher Raio
St Joseph Hospital
$241.06Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS L5430 vs. Other Prosthetic Fitting, Immediate Postsurgical or Early, Lower Limbs Codes
The HCPCS L5430 code is part of the Prosthetic Procedures services used for Prosthetic Fitting, Immediate Postsurgical or Early, 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 L5430 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 |
|---|---|---|
| L5420-HCPCS | High | Immediate post surgical or early fitting, application of initial rigid dressing, including fitting, alignment and suspension and one cast change 'AK' or knee disarticulation |
| L5430-HCPCS | Moderate | Immediate post surgical or early fitting, application of initial rigid dressing, incl. fitting, alignment and suspension, 'AK' or knee disarticulation, each additional cast change and realignment |
| L5450-HCPCS | Moderate | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, below knee |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5430 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS L5430) and we'll show you how you compare in 15 minutes or less.