HCPCS L5642 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Prosthetic Procedures • Various Prosthetic Sockets |
| Complexity Level | Moderate |
National average reimbursement for HCPCS L5642 by major payers:
$740.83
$435.26
$469.32
$967.13
| 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 L5642 | ||||||
United | L5642 | $276.61 | 1881630614 - QUEST DIAGNOSTICS LLC IL | 364257926 | IL | Clinical Medical Laboratory (291U00000X) |
United | L5642 | $370.98 | 1356860621 - CHI MEMORIAL HOSPITAL | 822748395 - CHI MEMORIAL HOSPITAL - GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | L5642 | $502.95 | 1518912666 - STEPHENS COUNTY ANESTHESIA SERVICES,LLC | 300429607 - (GA) STEPHENS COUNTY ANESTHESIA SERVICESLLC | GA | Rural Acute Care Hospital (282NR1301X) |
United | L5642 | $336.85 | 1356552350 - REDMOND PARK HOSPITAL LLC, REDMOND HOSPITAL BASED SERVICES LLC | 201017054 - (GA) REDMOND PARK HOSPITAL LLC | GA | General Acute Care Hospital (282N00000X) |
United | L5642 | $370.98 | 1831538743 - JACOB HOLLOWAY | 273818647 | GA | General Acute Care Hospital (282N00000X) |
United | L5642 | $1360.28 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | L5642 | $1255.46 | 1225281603 - EMORY CRAWFORD LONG HOSPITAL | 581537752 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | L5642 | $567.71 | 1033168257 - DUBLIN VAMC | 582080668 - (GA) DUBLIN VAMC | GA | General Acute Care Hospital (282N00000X) |
United | L5642 | $371.67 | 1366479099 - UNILAB CORPORATION, QUEST DIAGNOSTICS CLINICAL LAB | 710897031 | CA | Clinical Medical Laboratory (291U00000X) |
United | L5642 | $371.67 | 1881630614 - QUEST DIAGNOSTICS LLC IL | 364257926 | IL | Clinical Medical Laboratory (291U00000X) |
United | L5642 | $371.67 | 1750358297 - CITY OF HOPE NATIONAL MEDICAL CENTER | 951683875 - CITY OF HOPE NATIONAL MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | L5642 | $1298.45 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | L5642 | $1383.15 | 1588640692 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566256 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | L5642 | $322.97 | 1720095805 - DONALSONVILLE HOSPITAL INC | 580973772 - (GA) DONALSONVILLE HOSPITAL INC | GA | Rural Acute Care Hospital (282NR1301X) |
United | L5642 | $822.73 | 1689063554 - ATL COLORECTAL SURGERY | 205040872 - (GA) ATL COLORECTAL SURGERY | 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 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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