HCPCS L5981 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Prosthetic Procedures • Ankle and/or Foot Prosthetics and Additions |
| Complexity Level | High |
National average reimbursement for HCPCS L5981 by major payers:
$3,174.28
$2,081.39
$2,272.02
$4,805.12
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS L5981 | ||||||
United | L5981 | $1149.73 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | L5981 | $4609.20 | 1598798597 - ST. TAMMANY PARISH HOSPITAL SERVICE DISTRICT NO 1, ST. TAMMANY PARISH HOSPITAL | 720478620 | LA | General Acute Care Hospital (282N00000X) |
United | L5981 | $4609.20 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | L5981 | $4501.18 | 1396520862 - LAKE SURGICAL HOSPITAL SLIDELL, LLC | 474228147 - (LA) LAKE SURGICAL HOSPITAL SLIDELL, LLC DBA SOUTHERN SURGICAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | L5981 | $4501.18 | 1114976263 - SLIDELL MEMORIAL HOSPITAL, MD IMAGING SLIDELL | 726014895 - (LA) SLIDELL MEMORIAL HOSPITAL | LA | General Acute Care Hospital (282N00000X) |
United | L5981 | $6793.46 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | L5981 | $2431.57 | 1962462226 - TIFT REGIONAL HEALTH SYSTEM INC., TIFT REGIONAL MEDICAL CENTER | 453072990 - (GA) TIFT REGIONAL HEALTH SYSTEM INC | GA | General Acute Care Hospital (282N00000X) |
United | L5981 | $2115.35 | 1548290943 - BUFFALO REHAB GROUP PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PC | 161379851 - BUFFALO REHAB GROUP | NY | Physical Therapist (225100000X) |
United | L5981 | $2115.35 | 1548290943 - BUFFALO REHAB GROUP PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PC | 161379851 - BUFFALO REHAB GROUP | NY | Single Specialty Group (193400000X) |
United | L5981 | $1724.60 | 1619087590 - MIGUEL ARENAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | AZ | Gastroenterology Physician (207RG0100X) |
United | L5981 | $1793.56 | 1497944565 - MICHAEL SHULER | 581076549 - ATHENS ORTHOPEDIC CLINIC, P.A. | GA | Orthopaedic Hand Surgery Physician (207XS0106X) |
United | L5981 | $1965.02 | 1013514199 - KECK MEDICAL CENTER OF USC, KECK HOSPITAL OF USC | 851644866 - (CA) KECK MEDICAL CENTER OF USC | CA | General Acute Care Hospital (282N00000X) |
United | L5981 | $4501.18 | 1104057694 - SPECIALISTS HOSPITAL SHREVEPORT, LLC | 208810573 - (LA) SPECIALISTS HOSPITAL SHREVEPORT, L.L.C. | LA | General Acute Care Hospital (282N00000X) |
United | L5981 | $4609.20 | 1477882033 - SAVOY MEDICAL MANAGEMENT GROUP, INC., SAVOY MEDICAL CENTER HOSPITAL BASED PHYSICIANS | 800202027 - (LA) SAVOY MEDICAL MANAGEMENT GROUP INC | LA | General Acute Care Hospital (282N00000X) |
United | L5981 | $3917.83 | 1083903744 - HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST. BERNARD, STATE OF LOUIS, ST. BERNARD PARISH HOSPITAL | 261576974 - (LA) HOSPITAL SERVICE DISTRICT OF THE PARISH OF ST BERNARD STATE OF LOUIS | LA | Rural Acute Care Hospital (282NR1301X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS L5981 vs. Other Ankle and/or Foot Prosthetics and Additions Codes
The HCPCS L5981 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 L5981 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 |
|---|---|---|
| L5980-HCPCS | High | All lower extremity prostheses, flex foot system |
| L5981-HCPCS | High | All lower extremity prostheses, flex-walk system or equal |
| L5982-HCPCS | Moderate | All exoskeletal lower extremity prostheses, axial rotation unit |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L5981. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L5981 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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