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See a sample rate comparisonHCPCS L5704 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.
Custom shaped protective cover, below knee
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Custom-shaped Protective Covers |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5704 |
National average reimbursement for HCPCS L5704 by major payers:
$604.72
$380.12
$408.51
$880.33
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HCPCS L5704
5 of 25 sample ratesHigher to lower in this preview
Anna Jaques Hospital
$842.65Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$365.82Published rateBacon County Health Services, Inc, Bacon County Rural Health Clinic
Bacon County Health Services Inc
$320.95Published rateNorthside Hospital, Inc., Northside Hospital Duluth
$279.41Published rateChristopher Raio
Mercy Medical Center
$204.35Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L5704 vs. Other Custom-shaped Protective Covers Codes
The HCPCS L5704 code is part of the Prosthetic Procedures services used for Custom-shaped Protective Covers. 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 L5704 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 |
|---|---|---|
| L5703-HCPCS | High | Ankle, Symes, molded to patient model, socket without solid ankle cushion heel (SACH) foot, replacement only |
| L5704-HCPCS | Moderate | Custom shaped protective cover, below knee |
| L5705-HCPCS | High | Custom shaped protective cover, above knee |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5704. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5704 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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