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See a sample rate comparisonHCPCS L5855 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 system, hip disarticulation, mechanical hip extension assist
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5855 |
National average reimbursement for HCPCS L5855 by major payers:
$373.24
$220.50
$245.00
$441.53
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HCPCS L5855
5 of 25 sample ratesHigher to lower in this preview
Anna Jaques Hospital
$494.23Published rateThe Hospital Authority Of Monroe County, Georgia, Monroe County Hospital
The Hospital Authority Of Monroe County Georgia
$279.04Published rateHospital Authority Of Valdosta And Lowndes County Georgia, South Georgia Medical Center
Hospital Authority Of Valdosta And Lowndes County Georgia
$205.83Published rateAlicia Encinas
Miguel A Arenas Md PC
$184.92Published rateAlicia Encinas
Miguel A Arenas Md PC
$123.27Published rate
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See a sample payer proposalHCPCS L5855 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5855 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 L5855 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 |
|---|---|---|
| L5850-HCPCS | Low | Addition, endoskeletal system, above knee or hip disarticulation, knee extension assist |
| L5855-HCPCS | Moderate | Addition, endoskeletal system, hip disarticulation, mechanical hip extension assist |
| L5856-HCPCS | High | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5855 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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