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See a sample rate comparisonHCPCS L5962 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, belowknee, flexible protective outer surface covering system
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Endoskeletal Knee or Hip System Additions |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L5962 |
National average reimbursement for HCPCS L5962 by major payers:
$691.69
$417.04
$459.20
$838.55
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HCPCS L5962
5 of 25 sample ratesHigher to lower in this preview
Aztec Urgent Care, LLC
Aztec Urgent Care LLC
$898.73Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$838.76Published rateScottish Rite Childrens Medical Ctr, Children'S Healthcare Of Atlanta At Scottish Rite
Childrens Healthcare Of Atlanta Inc
$506.52Published rateHospital Authority Of Ben Hill, Dorminy Medical Center
$344.94Published rateAlicia Encinas
Miguel A Arenas Md PC
$234.63Published rate
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See a sample payer proposalHCPCS L5962 vs. Other Endoskeletal Knee or Hip System Additions Codes
The HCPCS L5962 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 L5962 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 |
|---|---|---|
| L5961-HCPCS | High | Addition, endoskeletal system, polycentric hip joint, pneumatic or hydraulic control, rotation control, with or without flexion and/or extension control |
| L5962-HCPCS | Moderate | Addition, endoskeletal system, belowknee, flexible protective outer surface covering system |
| L5964-HCPCS | High | Addition, endoskeletal system, above knee, flexible protective outer surface covering system |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5962. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5962 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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