HCPCS L8420 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Prosthetic Procedures • Prosthetic Sheaths, Socks, and Shrinkers |
| Complexity Level | Low |
National average reimbursement for HCPCS L8420 by major payers:
$21.75
$14.53
$16.19
$29.79
| 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 L8420 | ||||||
United | L8420 | $18.09 | 1619910627 - BRADLEY WEISNER | 562107759 - UROLOGY SPECIALISTS OF THE CAROLINAS, PLLC | NC | Urology Physician (208800000X) |
United | L8420 | $22.61 | 1992789721 - PHOEBE PUTNEY MEMORIAL HOSPITAL INC, PHOEBE PUTNEY MEMORIAL HOSPTIAL | 581928247 - (GA) PHOEBE PUTNEY MEMORIAL HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | L8420 | $15.01 | 1972731800 - MERIWETHER HEALTHCARE, L.L.C., WARM SPRINGS MEDICAL CENTER | 870764535 - (GA) MERIWETHER HEALTHCARE, LLC D/B/A WARM SPRINGS MEDICAL CENTER | GA | Critical Access Hospital (282NC0060X) |
United | L8420 | $50.77 | 1598964082 - EMORY HEALTHCARE | 582030692 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | L8420 | $22.61 | 1992789721 - PHOEBE PUTNEY MEMORIAL HOSPITAL INC, PHOEBE PUTNEY MEMORIAL HOSPTIAL | 263792403 - PHOEBE PHYSICIAN GROUP INC | GA | General Acute Care Hospital (282N00000X) |
United | L8420 | $15.01 | 1649646472 - LEIGH TAYLOR | 273818647 | GA | General Acute Care Hospital (282N00000X) |
United | L8420 | $12.76 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 262037695 - GRADY MEMORIAL HOSPITAL CORPORATION | GA | General Acute Care Hospital (282N00000X) |
United | L8420 | $15.56 | 1881630614 - QUEST DIAGNOSTICS LLC IL | 364257926 | IL | Clinical Medical Laboratory (291U00000X) |
United | L8420 | $14.63 | 1255478004 - CHRISTOPHER RAIO | 208243412 - SAMARITAN EMERGENCY MEDICAL SERVICES PC | NY | Emergency Medicine Physician (207P00000X) |
United | L8420 | $13.36 | 1588098172 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | 463316332 - PROGRESSIVE EMERGENCY PHYSICIANS PLLC | NY | Emergency Medicine Physician (207P00000X) |
United | L8420 | $13.61 | 1982658944 - PALMYRA PARK HOSPITAL, INC., PALMYRA MEDICAL CENTERS | 721553462 | GA | General Acute Care Hospital (282N00000X) |
United | L8420 | $15.56 | 1366479099 - UNILAB CORPORATION, QUEST DIAGNOSTICS CLINICAL LAB | 710897031 | CA | Clinical Medical Laboratory (291U00000X) |
United | L8420 | $15.56 | 1619040284 - QUEST DIAGNOSTICS VENTURE LLC | 232933949 | PA | Clinical Medical Laboratory (291U00000X) |
United | L8420 | $12.80 | 1366479099 - UNILAB CORPORATION, QUEST DIAGNOSTICS CLINICAL LAB | 710897031 | CA | Clinical Medical Laboratory (291U00000X) |
United | L8420 | $15.56 | 1366479099 - UNILAB CORPORATION, QUEST DIAGNOSTICS CLINICAL LAB | 710897031 | CA | Clinical Medical Laboratory (291U00000X) |
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 L8420 vs. Other Prosthetic Sheaths, Socks, and Shrinkers Codes
The HCPCS L8420 code is part of the Prosthetic Procedures services used for Prosthetic Sheaths, Socks, and Shrinkers. 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 L8420 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 |
|---|---|---|
| L8417-HCPCS | Low | Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each |
| L8420-HCPCS | Low | Prosthetic sock, multiple ply, below knee, each |
| L8430-HCPCS | Low | Prosthetic sock, multiple ply, above knee, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS L8420. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the L8420 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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