L0624
Prosthetics & Orthotics
53 States
Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
Short Desc
Sio panel custom
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2006-01-01
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$0.00
|
Same |
|
AL
|
Base Rate |
$0.00
|
Same |
|
AR
|
Base Rate |
$0.00
|
Same |
|
AZ
|
Base Rate |
$0.00
|
Same |
|
CA
|
Base Rate |
$0.00
|
Same |
|
CO
|
Base Rate |
$0.00
|
Same |
|
CT
|
Base Rate |
$0.00
|
Same |
|
DC
|
Base Rate |
$0.00
|
Same |
|
DE
|
Base Rate |
$0.00
|
Same |
|
FL
|
Base Rate |
$0.00
|
Same |
|
GA
|
Base Rate |
$0.00
|
Same |
|
HI
|
Base Rate |
$0.00
|
Same |
|
IA
|
Base Rate |
$0.00
|
Same |
|
ID
|
Base Rate |
$0.00
|
Same |
|
IL
|
Base Rate |
$0.00
|
Same |
|
IN
|
Base Rate |
$0.00
|
Same |
|
KS
|
Base Rate |
$0.00
|
Same |
|
KY
|
Base Rate |
$0.00
|
Same |
|
LA
|
Base Rate |
$0.00
|
Same |
|
MA
|
Base Rate |
$0.00
|
Same |
|
MD
|
Base Rate |
$0.00
|
Same |
|
ME
|
Base Rate |
$0.00
|
Same |
|
MI
|
Base Rate |
$0.00
|
Same |
|
MN
|
Base Rate |
$0.00
|
Same |
|
MO
|
Base Rate |
$0.00
|
Same |
|
MS
|
Base Rate |
$0.00
|
Same |
|
MT
|
Base Rate |
$0.00
|
Same |
|
NC
|
Base Rate |
$0.00
|
Same |
|
ND
|
Base Rate |
$0.00
|
Same |
|
NE
|
Base Rate |
$0.00
|
Same |
|
NH
|
Base Rate |
$0.00
|
Same |
|
NJ
|
Base Rate |
$0.00
|
Same |
|
NM
|
Base Rate |
$0.00
|
Same |
|
NV
|
Base Rate |
$0.00
|
Same |
|
NY
|
Base Rate |
$0.00
|
Same |
|
OH
|
Base Rate |
$0.00
|
Same |
|
OK
|
Base Rate |
$0.00
|
Same |
|
OR
|
Base Rate |
$0.00
|
Same |
|
PA
|
Base Rate |
$0.00
|
Same |
|
PR
|
Base Rate |
$0.00
|
Same |
|
RI
|
Base Rate |
$0.00
|
Same |
|
SC
|
Base Rate |
$0.00
|
Same |
|
SD
|
Base Rate |
$0.00
|
Same |
|
TN
|
Base Rate |
$0.00
|
Same |
|
TX
|
Base Rate |
$0.00
|
Same |
|
UT
|
Base Rate |
$0.00
|
Same |
|
VA
|
Base Rate |
$0.00
|
Same |
|
VI
|
Base Rate |
$0.00
|
Same |
|
VT
|
Base Rate |
$0.00
|
Same |
|
WA
|
Base Rate |
$0.00
|
Same |
|
WI
|
Base Rate |
$0.00
|
Same |
|
WV
|
Base Rate |
$0.00
|
Same |
|
WY
|
Base Rate |
$0.00
|
Same |