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See a sample rate comparisonHCPCS L5642 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, above knee, leather socket
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Various Prosthetic Sockets |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5642 |
National average reimbursement for HCPCS L5642 by major payers:
$740.83
$435.26
$469.32
$967.13
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HCPCS L5642
5 of 25 sample ratesHigher to lower in this preview
Emory University, Emory University Hospital
Emory University
$1,383.15Published rateAtl Colorectal Surgery
$822.73Published rateCity Of Hope National Medical Center
$371.67Published rateApril Leuzinger
Aztec Urgent Care LLC
$343.01Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$276.61Published rate
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See a sample payer proposalHCPCS L5642 vs. Other Various Prosthetic Sockets Codes
The HCPCS L5642 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 L5642 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 |
|---|---|---|
| L5640-HCPCS | Moderate | Addition to lower extremity, knee disarticulation, leather socket |
| L5642-HCPCS | Moderate | Addition to lower extremity, above knee, leather socket |
| L5643-HCPCS | High | Addition to lower extremity, hip disarticulation, flexible inner socket, external frame |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5642. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5642 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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