HCPCS L5610 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Prosthetic Procedures • Endoskeletal Prosthetic Additions, Lower Extremities |
| Complexity Level | High |
National average reimbursement for HCPCS L5610 by major payers:
$2,519.69
$1,487.64
$1,650.52
$3,533.58
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS L5610 | ||||||
United | L5610 | $1239.72 | 1255478004 - CHRISTOPHER RAIO | 113438973 - ST JOSEPH HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | L5610 | $1239.71 | 1306136551 - UJUKA ILOABUCHI | 582422542 - ATLANTA WOMENS HEALTH GROUP, P.C. | GA | Women's Hospital (282NW0100X) |
United | L5610 | $1079.25 | 1497064679 - JENKINS COUNTY HOSPITAL LLC, OPTIM MEDICAL CENTER - JENKINS | 581158547 - (GA) HOSPITAL AUTHORITY OF JENKINS COUNTY DBA JENKINS COUNTY MEDICAL CENTER | GA | Critical Access Hospital (282NC0060X) |
United | L5610 | $4195.35 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 581537752 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | L5610 | $1125.66 | 1306890942 - BROOKS COUNTY HOSPITAL | 586002830 | GA | Critical Access Hospital (282NC0060X) |
United | L5610 | $5184.65 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | L5610 | $1897.10 | 1801844469 - AUGUSTA VAMC | 582089405 - AUGUSTA VAMC | GA | General Acute Care Hospital (282N00000X) |
United | L5610 | $2899.65 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | L5610 | $1568.04 | 1376574277 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL FORSYTH | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | L5610 | $1079.25 | 1720189517 - TAYLOR REGIONAL HOSPITAL | 580655369 - (GA) TAYLOR REGIONAL HOSPITAL | GA | Rural Acute Care Hospital (282NR1301X) |
United | L5610 | $1652.95 | 1689744450 - ARTHUR M. BLANK HOSPITAL, INC., ARTHUR M. BLANK HOSPITAL | 582147112 - (GA) CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | L5610 | $1187.96 | 1730110826 - EVANS MEMORIAL HOSPITAL, INC. | 582257925 - (GA) EVANS MEMORIAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | L5610 | $1125.66 | 1245248624 - HOSPITAL AUTHORITY OF BEN HILL, DORMINY MEDICAL CENTER | 581157005 | GA | Rural Acute Care Hospital (282NR1301X) |
United | L5610 | $4195.35 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 582030692 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | L5610 | $1897.10 | 1033168257 - DUBLIN VAMC | 582080668 - (GA) DUBLIN VAMC | GA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS L5610 vs. Other Endoskeletal Prosthetic Additions, Lower Extremities Codes
The HCPCS L5610 code is part of the Prosthetic Procedures services used for Endoskeletal Prosthetic Additions, Lower Extremities. 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 L5610 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 |
|---|---|---|
| L5600-HCPCS | High | Preparatory, hip disarticulation-hemipelvectomy, pylon, no cover, SACH foot, laminated socket, molded to patient model |
| L5610-HCPCS | High | Addition to lower extremity, endoskeletal system, above knee, hydracadence system |
| L5611-HCPCS | High | Addition to lower extremity, endoskeletal system, above knee-knee disarticulation, 4 bar linkage, with friction swing phase control |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5610. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5610 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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