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See a sample rate comparisonHCPCS L5968 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 limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Ankle and/or Foot Prosthetics and Additions |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5968 |
National average reimbursement for HCPCS L5968 by major payers:
$3,688.17
$2,367.28
$2,625.16
$5,160.67
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HCPCS L5968
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$7,832.48Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$3,528.56Published rateMeriwether Healthcare, L.L.C., Warm Springs Medical Center
Meriwether Healthcare, LLC D/B/A Warm Springs Medical Center
$2,200.44Published rateJeremy Kelley
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$1,955.11Published rateKristina Jimenez
Miguel A Arenas Md PC
$1,303.42Published rate
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See a sample payer proposalHCPCS L5968 vs. Other Ankle and/or Foot Prosthetics and Additions Codes
The HCPCS L5968 code is part of the Prosthetic Procedures services used for Ankle and/or Foot Prosthetics and 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 L5968 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 |
|---|---|---|
| L5966-HCPCS | High | Addition, endoskeletal system, hip disarticulation, flexible protective outer surface covering system |
| L5968-HCPCS | High | Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature |
| L5969-HCPCS | High | Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5968. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5968 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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