Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonHCPCS L7405 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, shoulder disarticulation/interscapular thoracic, acrylic material
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Additions for Upper Extremity Prosthetics |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for L7405 |
National average reimbursement for HCPCS L7405 by major payers:
$743.27
$473.51
$520.72
$991.19
Compare published rates across providers.
Choose a payer to see a sample of rates for HCPCS L7405.
HCPCS L7405
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$1,566.81Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$886.81Published rateGeorge Hemstreet
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$464.11Published rateBama Heart Doc, P.C., Alabama Heart And Vascular Medicine
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$391.10Published rateMiguel Arenas
Miguel A Arenas Md PC
$260.73Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalHCPCS L7405 vs. Other Additions for Upper Extremity Prosthetics Codes
The HCPCS L7405 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 L7405 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 |
|---|---|---|
| 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 |
| L7499-HCPCS | High | Upper extremity prosthesis, not otherwise specified |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L7405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L7405 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS L7405) and we'll show you how you compare in 15 minutes or less.