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See a sample rate comparisonHCPCS L5845 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, stance flexion feature, adjustable
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5845 |
National average reimbursement for HCPCS L5845 by major payers:
$1,751.73
$1,168.08
$1,295.26
$2,552.65
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HCPCS L5845
5 of 25 sample ratesHigher to lower in this preview
Emory Healthcare
Emory University
$3,672.95Published rateQuest Diagnostics Incorporated
$1,055.55Published rateJohn D. Archbold Memorial Hospital, Inc.
John D Archbold Memorial Hospital Inc
$985.47Published rateNgmc Barrow LLC, Ngmc Barrow
Gainesville Radiology Group
$964.33Published rateGood Samaritan Hospital, Inc., St. Mary'S Good Samaritan Hospital
Good Samaritan Hospital Inc
$723.57Published rate
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See a sample payer proposalHCPCS L5845 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5845 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 L5845 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 |
|---|---|---|
| L5840-HCPCS | High | Addition, endoskeletal knee/shin system, 4-bar linkage or multiaxial, pneumatic swing phase control |
| L5845-HCPCS | High | Addition, endoskeletal, knee-shin system, stance flexion feature, adjustable |
| L5848-HCPCS | High | Addition to endoskeletal knee-shin system, fluid stance extension, dampening feature, with or without adjustability |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5845. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5845 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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