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See a sample rate comparisonHCPCS L5828 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, single axis, fluid 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 L5828 |
National average reimbursement for HCPCS L5828 by major payers:
$2,915.94
$2,038.81
$2,144.32
$4,189.66
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HCPCS L5828
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$8,266.81Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$2,066.29Published rateBacon County Health Services, Inc, Bacon County Rural Health Clinic
Bacon County Health Services Inc
$1,690.93Published rateHospital Authority Of Mitchell County, Mitchell County Hospital
Hospital Authority Of Mitchell County
$1,535.35Published rateDonalsonville Hospital Inc
$1,472.06Published rate
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See a sample payer proposalHCPCS L5828 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5828 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 L5828 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 |
|---|---|---|
| L5826-HCPCS | High | Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame |
| L5828-HCPCS | High | Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control |
| L5830-HCPCS | High | Addition, endoskeletal knee-shin system, single axis, pneumatic/ swing 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 L5828. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5828 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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