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See a sample rate comparisonHCPCS L5856 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 to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5856 |
National average reimbursement for HCPCS L5856 by major payers:
$23,598.16
$15,598.88
$17,161.71
$22,515.32
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HCPCS L5856
5 of 25 sample ratesHigher to lower in this preview
Emory University, Emory University Hospital
Emory University
$54,195.23Published rateAztec Urgent Care, LLC
Aztec Urgent Care LLC
$19,483.75Published rateLower Oconee Community Hospital Inc
$13,198.79Published rateThe Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$12,654.66Published rateAlicia Encinas
Miguel A Arenas Md PC
$8,622.87Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L5856 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5856 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 L5856 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 |
|---|---|---|
| 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 |
| L5857-HCPCS | High | Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing phase only, 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 L5856. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5856 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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