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See a sample rate comparisonHCPCS L5694 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, above knee, pelvic control belt, padded and lined
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Socket Insert, Suspensions, and Other Prosthetic Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5694 |
National average reimbursement for HCPCS L5694 by major payers:
$211.44
$128.01
$143.06
$258.03
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HCPCS L5694
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$506.94Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
Quest Diagnostics Clinical Laboratories, Inc.
$145.10Published rateMichael Koch
Pathology Lab Of Georgia LLC
$108.62Published rateBrooks County Hospital
$98.62Published rateGrady Memorial Hospital Corporation, Grady Health Systems
Grady Memorial Hospital Corporation
$92.33Published rate
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See a sample payer proposalHCPCS L5694 vs. Other Socket Insert, Suspensions, and Other Prosthetic Additions Codes
The HCPCS L5694 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 L5694 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 |
|---|---|---|
| L5692-HCPCS | Low | Addition to lower extremity, above knee, pelvic control belt, light |
| L5694-HCPCS | Moderate | Addition to lower extremity, above knee, pelvic control belt, padded and lined |
| L5695-HCPCS | Low | Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5694. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5694 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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