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See a sample rate comparisonHCPCS L5616 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.
Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Prosthetic Additions, Lower Extremities |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5616 |
National average reimbursement for HCPCS L5616 by major payers:
$1,459.40
$953.93
$1,066.00
$2,083.11
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HCPCS L5616
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$3,366.37Published rateTift Regional Health System, Inc., Southwell Medical
Tift Regional Health System Inc
$1,105.06Published rateUpson County Hospital Inc, Upson Regional Medical Center
Upson County Hospital Inc
$815.10Published rateScreven County Hospital
$781.08Published rateGrady Memorial Hospital Corporation, Grady Health Systems
Grady Memorial Hospital Corporation
$692.84Published rate
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See a sample payer proposalHCPCS L5616 vs. Other Endoskeletal Prosthetic Additions, Lower Extremities Codes
The HCPCS L5616 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 L5616 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 |
|---|---|---|
| L5614-HCPCS | High | Addition to lower extremity, exoskeletal system, above knee-knee disarticulation, 4 bar linkage, with pneumatic swing phase control |
| L5616-HCPCS | High | Addition to lower extremity, endoskeletal system, above knee, universal multiplex system, friction swing phase control |
| L5617-HCPCS | Moderate | Addition to lower extremity, quick change self-aligning unit, above knee or below knee, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5616. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5616 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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