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See a sample rate comparisonHCPCS L5500 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.
Initial, below knee 'PTB' type socket, non-alignable system, pylon, no cover, SACH foot, plaster socket, direct formed
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Supply, Initial Prosthesis |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5500 |
National average reimbursement for HCPCS L5500 by major payers:
$1,424.71
$918.04
$997.55
$2,081.23
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HCPCS L5500
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$3,211.46Published rateAugusta Vamc
$1,176.83Published rateKamran Rajaee
$769.03Published rateChatuge Regional Hospital Inc
$669.48Published rateQuest Diagnostics Venture LLC
$172.94Published rate
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See a sample payer proposalHCPCS L5500 vs. Other Supply, Initial Prosthesis Codes
The HCPCS L5500 code is part of the Prosthetic Procedures services used for Supply, Initial Prosthesis. 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 L5500 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 |
|---|---|---|
| L5460-HCPCS | Moderate | Immediate post surgical or early fitting, application of non-weight bearing rigid dressing, above knee |
| L5500-HCPCS | High | Initial, below knee 'PTB' type socket, non-alignable system, pylon, no cover, SACH foot, plaster socket, direct formed |
| L5505-HCPCS | High | Initial, above knee - knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, SACH foot, plaster socket, direct formed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5500. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5500 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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