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See a sample rate comparisonHCPCS L5816 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, endoskeletal knee-shin system, polycentric, mechanical stance phase lock
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5816 |
National average reimbursement for HCPCS L5816 by major payers:
$893.03
$591.82
$643.67
$1,208.49
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HCPCS L5816
5 of 25 sample ratesHigher to lower in this preview
Emory University Hospital
Emory University
$1,733.71Published ratePhoebe Worth Medical Center, Inc, Phoebe Worth Medical Center, Inc
Phoebe Worth Medical Center Inc
$771.70Published rateQuest Diagnostics LLC Il
$628.00Published rateNgmc Barrow LLC, Ngmc Barrow
Gainesville Radiology Group
$509.23Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$339.49Published rate
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See a sample payer proposalHCPCS L5816 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5816 code is part of the Prosthetic Procedures services used for Endoskeletal Knee or Hip System 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 L5816 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 |
|---|---|---|
| L5814-HCPCS | High | Addition, endoskeletal knee-shin system, polycentric, hydraulic swing phase control, mechanical stance phase lock |
| L5816-HCPCS | Moderate | Addition, endoskeletal knee-shin system, polycentric, mechanical stance phase lock |
| L5818-HCPCS | High | Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5816. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5816 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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