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See a sample rate comparisonHCPCS L5643 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, hip disarticulation, flexible inner socket, external frame
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Various Prosthetic Sockets |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5643 |
National average reimbursement for HCPCS L5643 by major payers:
$1,833.83
$1,106.57
$1,205.79
$2,794.28
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HCPCS L5643
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$4,556.33Published ratePiedmont Newton Hospital, Inc., Newton Medical Center
Piedmont Newton Hospital Inc
$2,066.85Published rateMeriwether County Hospital Authority, Warm Springs Medical Center
Meriwether Healthcare, LLC D/B/A Warm Springs Medical Center
$931.97Published rateBrooks County Hospital
$846.22Published rateGood Samaritan Hospital, Inc., St. Mary'S Good Samaritan Hospital
Good Samaritan Hospital Inc
$621.32Published rate
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See a sample payer proposalHCPCS L5643 vs. Other Various Prosthetic Sockets Codes
The HCPCS L5643 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 L5643 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 |
|---|---|---|
| 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 |
| L5644-HCPCS | Moderate | Addition to lower extremity, above knee, wood socket |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5643. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5643 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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