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See a sample rate comparisonHCPCS L5940 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, below knee, ultra-light material (titanium, carbon fiber or equal)
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5940 |
National average reimbursement for HCPCS L5940 by major payers:
$550.27
$353.23
$398.45
$714.86
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HCPCS L5940
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,101.32Published ratePhoebe Worth Medical Center, Inc, Phoebe Worth Medical Center, Inc
Phoebe Worth Medical Center Inc
$452.45Published rateUnilab Corporation, Quest Diagnostics Clinical Lab
$319.80Published rateHospital Authority Of Mitchell County, Mitchell County Hospital
Hospital Authority Of Mitchell County
$272.72Published rateQuest Diagnostics LLC Il
$249.60Published rate
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See a sample payer proposalHCPCS L5940 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5940 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 L5940 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 |
|---|---|---|
| L5930-HCPCS | High | Addition, endoskeletal system, high activity knee control frame |
| L5940-HCPCS | Moderate | Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
| L5950-HCPCS | Moderate | Addition, endoskeletal system, above knee, ultra-light material (titanium, carbon fiber or equal) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5940. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5940 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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