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See a sample rate comparisonHCPCS L5679 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, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Socket Insert, Suspensions, and Other Prosthetic Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5679 |
National average reimbursement for HCPCS L5679 by major payers:
$619.16
$399.77
$440.14
$929.16
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HCPCS L5679
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,443.35Published rateEmory Healthcare
Emory University
$1,200.67Published rateKamran Rajaee
$354.79Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$308.86Published rateAlicia Encinas
Miguel A Arenas Md PC
$222.27Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L5679 vs. Other Socket Insert, Suspensions, and Other Prosthetic Additions Codes
The HCPCS L5679 code is part of the Prosthetic Procedures services used for Socket Insert, Suspensions, and Other Prosthetic Additions. 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 L5679 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 |
|---|---|---|
| L5678-HCPCS | Low | Additions to lower extremity, below knee, joint covers, pair |
| L5679-HCPCS | Moderate | Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism |
| L5680-HCPCS | Moderate | Addition to lower extremity, below knee, thigh lacer, nonmolded |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5679. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5679 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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