HCPCS L5680 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 • Socket Insert, Suspensions, and Other Prosthetic Additions |
| Complexity Level | Moderate |
National average reimbursement for HCPCS L5680 by major payers:
$345.67
$221.61
$238.66
$432.99
| 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 L5680 | ||||||
United | L5680 | $269.05 | 1033435664 - SMITH OF GEORGIA, SMITH NORTHVIEW HOSPITALISTS | 271652335 - (GA) SMITH OF GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | L5680 | $168.69 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | L5680 | $198.47 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | L5680 | $487.08 | 1992779482 - ANNA JAQUES HOSPITAL | 42104338 - (MA) ANNA JAQUES HOSPITAL | MA | General Acute Care Hospital (282N00000X) |
United | L5680 | $186.82 | 1790942381 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM MEDICAL CENTER - TATTNALL | 300466706 | GA | Critical Access Hospital (282NC0060X) |
United | L5680 | $132.30 | 1346209137 - GOOD SAMARITAN HOSPITAL, INC., ST. MARY'S GOOD SAMARITAN HOSPITAL | 261720984 - (GA) GOOD SAMARITAN HOSPITAL INC | GA | Critical Access Hospital (282NC0060X) |
United | L5680 | $487.08 | 1619061769 - ANNA JAQUES HOSPITAL | 42104338 - (MA) ANNA JAQUES HOSPITAL | MA | Psychiatric Hospital Unit (273R00000X) |
United | L5680 | $191.30 | 1619040284 - QUEST DIAGNOSTICS VENTURE LLC | 232933949 | PA | Clinical Medical Laboratory (291U00000X) |
United | L5680 | $190.17 | 1245201094 - SCREVEN COUNTY HOSPITAL | 273100946 | GA | Critical Access Hospital (282NC0060X) |
United | L5680 | $198.47 | 1629185285 - BACON COUNTY HEALTH SERVICES, INC. | 582224545 - (GA) BACON COUNTY HEALTH SERVICES INC | GA | Critical Access Hospital (282NC0060X) |
United | L5680 | $198.47 | 1659376630 - UPSON COUNTY HOSPITAL INC, UPSON REGIONAL MEDICAL CENTER | 581734026 - (GA) UPSON COUNTY HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | L5680 | $251.02 | 1376574277 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL FORSYTH | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | L5680 | $264.61 | 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 | L5680 | $150.02 | 1023055126 - HCA HEALTH SERVICES OF TENNESSEE, INC., TRISTAR CENTENNIAL MEDICAL CENTER | 382084239 - QUEST DIAGNOSTICS CLINICAL LABORATORIES, INC. | TN | General Acute Care Hospital (282N00000X) |
United | L5680 | $150.02 | 1881630614 - QUEST DIAGNOSTICS LLC IL | 364257926 | IL | Clinical Medical Laboratory (291U00000X) |
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 L5680 vs. Other Socket Insert, Suspensions, and Other Prosthetic Additions Codes
The HCPCS L5680 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 L5680 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 |
|---|---|---|
| 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, not for use with locking mechanism |
| L5680-HCPCS | Moderate | Addition to lower extremity, below knee, thigh lacer, nonmolded |
| L5681-HCPCS | High | Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5680. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5680 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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