HCPCS L5649 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Prosthetic Procedures • Various Prosthetic Sockets |
| Complexity Level | High |
National average reimbursement for HCPCS L5649 by major payers:
$2,225.04
$1,401.28
$1,619.74
$3,462.00
| 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 L5649 | ||||||
United | L5649 | $1904.68 | 1922178789 - SCOTTISH RITE CHILDRENS MEDICAL CTR, CHILDREN'S HEALTHCARE OF ATLANTA AT SCOTTISH RITE | 580572465 - CHILDRENS HEALTHCARE OF ATLANTA INC | GA | Children's Hospital (282NC2000X) |
United | L5649 | $1541.88 | 1255401519 - THE MEDICAL CENTER INC, PIEDMONT COLUMBUS REGIONAL MIDTOWN | 581685139 - (GA) THE MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | L5649 | $5325.89 | 1588640692 - EMORY UNIVERSITY, EMORY UNIVERSITY HOSPITAL | 580566256 - (GA) EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | L5649 | $1368.88 | 1790888089 - HOSPITAL AUTHORITY OF CANDLER COUNTY, CANDLER COUNTY HOSPITAL | 586004640 | GA | Critical Access Hospital (282NC0060X) |
United | L5649 | $2380.85 | 1528056066 - HAMILTON MEDICAL CENTER, INC. | 581519911 - HAMILTON MEDICAL CENTER INC | GA | General Acute Care Hospital (282N00000X) |
United | L5649 | $1243.58 | 1497064679 - JENKINS COUNTY HOSPITAL LLC, OPTIM MEDICAL CENTER - JENKINS | 581158547 - (GA) HOSPITAL AUTHORITY OF JENKINS COUNTY DBA JENKINS COUNTY MEDICAL CENTER | GA | Critical Access Hospital (282NC0060X) |
United | L5649 | $1368.88 | 1811962756 - EFFINGHAM HOSPITAL, INC., EFFINGHAM HEALTH SYSTEM | 474393589 - (GA) EFFINGHAM HOSPITAL INC | GA | Critical Access Hospital (282NC0060X) |
United | L5649 | $1368.88 | 1326079260 - HOSPITAL AUTHORITY OF LIBERTY COUNTY, LIBERTY REGIONAL MEDICAL CENTER | 586025016 | GA | Critical Access Hospital (282NC0060X) |
United | L5649 | $1297.06 | 1982658944 - PALMYRA PARK HOSPITAL, INC., PALMYRA MEDICAL CENTERS | 721553462 | GA | General Acute Care Hospital (282N00000X) |
United | L5649 | $1297.06 | 1306890942 - BROOKS COUNTY HOSPITAL | 586002830 | GA | Critical Access Hospital (282NC0060X) |
United | L5649 | $880.00 | 1023055126 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR CENTENNIAL MEDICAL CENTER | 382084239 - QUEST DIAGNOSTICS CLINICAL LABORATORIES, INC. | TN | General Acute Care Hospital (282N00000X) |
United | L5649 | $1149.59 | 1932145778 - QUEST DIAGNOSTICS INCORPORATED | 161387862 - QUEST DIAGNOSTICS INCORPORATED | NJ | Clinical Medical Laboratory (291U00000X) |
United | L5649 | $1428.51 | 1710992433 - HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE, JEFFERSON HOSPITAL | 581309961 - (GA) HOSPITAL AUTHORITY OF JEFFERSON COUNTY AND THE CITY OF LOUISVILLE | GA | General Acute Care Hospital (282N00000X) |
United | L5649 | $2151.84 | 1639157431 - PHOEBE WORTH MEDICAL CENTER, INC, PHOEBE WORTH MEDICAL CENTER, INC | 383647394 - (GA) PHOEBE WORTH MEDICAL CENTER INC | GA | Critical Access Hospital (282NC0060X) |
United | L5649 | $4109.24 | 1598964082 - EMORY HEALTHCARE | 582030692 - EMORY UNIVERSITY | 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 L5649 vs. Other Various Prosthetic Sockets Codes
The HCPCS L5649 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 L5649 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 |
|---|---|---|
| L5648-HCPCS | Moderate | Addition to lower extremity, above knee, air, fluid, gel or equal, cushion socket |
| L5649-HCPCS | High | Addition to lower extremity, ischial containment/narrow M-L socket |
| L5650-HCPCS | Moderate | Additions to lower extremity, total contact, above knee or knee disarticulation socket |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5649. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5649 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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