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See a sample rate comparisonHCPCS L5540 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.
Preparatory, below knee 'PTB' type socket, non-alignable system, pylon, no cover, SACH foot, laminated socket, molded to model
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Supply, Preparatory Prosthesis |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5540 |
National average reimbursement for HCPCS L5540 by major payers:
$2,095.12
$1,295.75
$1,422.17
$2,918.36
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HCPCS L5540
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$4,532.58Published rateQuest Diagnostics LLC Il
$1,446.77Published rateJacob Holloway
$1,083.78Published ratePaulding Medical Center, Inc., Wellstar Paulding Hospital
Paulding Medical Center Inc
$943.48Published rateMiguel Arenas
Miguel A Arenas Md PC
$722.52Published rate
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See a sample payer proposalHCPCS L5540 vs. Other Supply, Preparatory Prosthesis Codes
The HCPCS L5540 code is part of the Prosthetic Procedures services used for Supply, Preparatory 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 L5540 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 |
|---|---|---|
| L5535-HCPCS | High | Preparatory, below knee 'PTB' type socket, non-alignable system, no cover, SACH foot, prefabricated, adjustable open end socket |
| L5540-HCPCS | High | Preparatory, below knee 'PTB' type socket, non-alignable system, pylon, no cover, SACH foot, laminated socket, molded to model |
| L5560-HCPCS | High | Preparatory, above knee- knee disarticulation, ischial level socket, non-alignable system, pylon, no cover, SACH foot, plaster socket, molded to model |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5540. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5540 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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