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See a sample rate comparisonHCPCS L5696 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 or knee disarticulation, pelvic joint
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Socket Insert, Suspensions, and Other Prosthetic Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5696 |
National average reimbursement for HCPCS L5696 by major payers:
$219.71
$133.53
$145.75
$278.09
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HCPCS L5696
5 of 25 sample ratesHigher to lower in this preview
Anna Jaques Hospital
$296.08Published rateKeck Medical Center Of Usc, Keck Hospital Of Usc
Keck Medical Center Of Usc
$156.00Published rateHospital Authority Of Valdosta And Lowndes County Georgia, South Georgia Medical Center
Hospital Authority Of Valdosta And Lowndes County Georgia
$110.79Published rateHospital Authority Of Ben Hill, Dorminy Medical Center
$100.58Published rateAlicia Encinas
Miguel A Arenas Md PC
$73.86Published rate
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See a sample payer proposalHCPCS L5696 vs. Other Socket Insert, Suspensions, and Other Prosthetic Additions Codes
The HCPCS L5696 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 L5696 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 |
|---|---|---|
| L5695-HCPCS | Low | Addition to lower extremity, above knee, pelvic control, sleeve suspension, neoprene or equal, each |
| L5696-HCPCS | Moderate | Addition to lower extremity, above knee or knee disarticulation, pelvic joint |
| L5697-HCPCS | Low | Addition to lower extremity, above knee or knee disarticulation, pelvic band |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5696. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5696 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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