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See a sample rate comparisonHCPCS L5818 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Addition, endoskeletal knee-shin system, polycentric, friction swing, and stance phase control
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5818 |
National average reimbursement for HCPCS L5818 by major payers:
$1,032.25
$681.86
$720.19
$1,373.29
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HCPCS L5818
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$2,811.25Published rateThe Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$1,327.70Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
Quest Diagnostics Clinical Laboratories, Inc.
$768.00Published rateHospital Authority Of Washington County, Washington County Regional Medical Center
$541.27Published rateGood Samaritan Hospital, Inc., St. Mary'S Good Samaritan Hospital
Good Samaritan Hospital Inc
$383.35Published rate
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See a sample payer proposalHCPCS L5818 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5818 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 L5818 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 |
|---|---|---|
| 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 |
| L5822-HCPCS | High | Addition, endoskeletal knee-shin system, single axis, pneumatic swing, friction 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 L5818. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5818 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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