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See a sample rate comparisonHCPCS L5969 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, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s)
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Ankle and/or Foot Prosthetics and Additions |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L5969 |
National average reimbursement for HCPCS L5969 by major payers:
$9,216.13
$9,321.52
$16,734.51
$15,565.67
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HCPCS L5969
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$29,437.19Published rateThe Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$19,986.01Published rateThe Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$11,025.73Published rateMichael Koch
Chestatee Pathology Associates PC
$8,270.08Published rateGood Samaritan Hospital, Inc., St. Mary'S Good Samaritan Hospital
Good Samaritan Hospital Inc
$5,513.37Published rate
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See a sample payer proposalHCPCS L5969 vs. Other Ankle and/or Foot Prosthetics and Additions Codes
The HCPCS L5969 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 L5969 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 |
|---|---|---|
| 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) |
| L5970-HCPCS | Moderate | All lower extremity prostheses, foot, external keel, solid ankle cushion heel (SACH) foot |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5969. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5969 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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