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See a sample rate comparisonHCPCS L5640 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.
Addition to lower extremity, knee disarticulation, leather socket
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Various Prosthetic Sockets |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5640 |
National average reimbursement for HCPCS L5640 by major payers:
$777.10
$465.02
$493.61
$1,043.03
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HCPCS L5640
5 of 25 sample ratesHigher to lower in this preview
Christopher Raio
Mercy Medical Center
$1,138.09Published rateNorthside Hospital, Inc., Northside Hospital Forsyth
Northside Hospital Inc
$484.29Published rateQuest Diagnostics LLC Il
$406.79Published rateElbert Memorial Hospital
$347.66Published rateWildwood Sanitarium Incorporated, Wildwood Medical Clinic
Wildwood Sanitarium Incorporated
$255.25Published rate
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See a sample payer proposalHCPCS L5640 vs. Other Various Prosthetic Sockets Codes
The HCPCS L5640 code is part of the Prosthetic Procedures services used for Various Prosthetic Sockets. 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 L5640 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 |
|---|---|---|
| L5639-HCPCS | High | Addition to lower extremity, below knee, wood socket |
| L5640-HCPCS | Moderate | Addition to lower extremity, knee disarticulation, leather socket |
| L5642-HCPCS | Moderate | Addition to lower extremity, above knee, leather socket |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5640. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5640 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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