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See a sample rate comparisonHCPCS L7404 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 to upper extremity prosthesis, above elbow disarticulation, acrylic material
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Additions for Upper Extremity Prosthetics |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L7404 |
National average reimbursement for HCPCS L7404 by major payers:
$562.48
$362.06
$399.33
$546.73
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HCPCS L7404
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,198.01Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$539.65Published rateMichael Koch
Chestatee Pathology Associates PC
$336.54Published rateAlicia Encinas
Miguel A Arenas Md PC
$299.04Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$196.04Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS L7404 vs. Other Additions for Upper Extremity Prosthetics Codes
The HCPCS L7404 code is part of the Prosthetic Procedures services used for Additions for Upper Extremity 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 L7404 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 |
|---|---|---|
| L7403-HCPCS | Moderate | Addition to upper extremity prosthesis, below elbow/wrist disarticulation, acrylic material |
| L7404-HCPCS | Moderate | Addition to upper extremity prosthesis, above elbow disarticulation, acrylic material |
| L7405-HCPCS | Moderate | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L7404. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L7404 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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