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See a sample rate comparisonHCPCS L7499 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.
Upper extremity prosthesis, not otherwise specified
| Key Fact | Detail |
|---|---|
| Service Type | Prosthetic Procedures Upper Extremity Prosthetics, Not Otherwise Specified (NOS) |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for L7499 |
National average reimbursement for HCPCS L7499 by major payers:
$1,632.97
$519.00
$49.42
$5,665.25
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HCPCS L7499
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See a sample payer proposalHCPCS L7499 vs. Other Upper Extremity Prosthetics, Not Otherwise Specified (NOS) Codes
The HCPCS L7499 code is part of the Prosthetic Procedures services used for Upper Extremity Prosthetics, Not Otherwise Specified (NOS). 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 L7499 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 |
|---|---|---|
| L7405-HCPCS | Moderate | Addition to upper extremity prosthesis, shoulder disarticulation/interscapular thoracic, acrylic material |
| L7499-HCPCS | High | Upper extremity prosthesis, not otherwise specified |
| L7510-HCPCS | Low | Repair of prosthetic device, repair or replace minor parts |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L7499. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L7499 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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