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See a sample rate comparisonHCPCS L6965 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.
Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures External Power Upper Limb Prosthetics |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L6965 |
National average reimbursement for HCPCS L6965 by major payers:
$15,190.25
$9,929.23
$11,063.54
$21,501.03
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HCPCS L6965
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$32,746.52Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$8,900.62Published rateMiguel Arenas
Miguel A Arenas Md PC
$8,486.38Published rateHca Health Services Of Tennessee, Inc., Tristar Centennial Medical Center
$7,600.00Published rateGrady Memorial Hospital Corporation, Grady Health Systems
Grady Memorial Hospital Corporation
$7,344.02Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L6965 vs. Other External Power Upper Limb Prosthetics Codes
The HCPCS L6965 code is part of the Prosthetic Procedures services used for External Power Upper Limb Prosthetics. 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 L6965 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 |
|---|---|---|
| L6960-HCPCS | High | Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
| L6965-HCPCS | High | Shoulder disarticulation, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device |
| L6970-HCPCS | High | Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, Otto Bock or equal switch, cables, two batteries and one charger, switch control of terminal device |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L6965. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L6965 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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