L0626
Prosthetics & Orthotics
53 States
Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Short Desc
Lo sag rig pnl stays pre cst
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2014-01-01
National Floor
$85.59
National Ceiling
$114.12
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$93.48
|
Same |
|
AL
|
Base Rate |
$96.32
|
Same |
|
AR
|
Base Rate |
$96.31
|
Same |
|
AZ
|
Base Rate |
$93.48
|
Same |
|
CA
|
Base Rate |
$93.48
|
Same |
|
CO
|
Base Rate |
$97.02
|
Same |
|
CT
|
Base Rate |
$93.48
|
Same |
|
DC
|
Base Rate |
$93.48
|
Same |
|
DE
|
Base Rate |
$93.48
|
Same |
|
FL
|
Base Rate |
$96.32
|
Same |
|
GA
|
Base Rate |
$96.32
|
Same |
|
HI
|
Base Rate |
$93.48
|
Same |
|
IA
|
Base Rate |
$95.33
|
Same |
|
ID
|
Base Rate |
$93.48
|
Same |
|
IL
|
Base Rate |
$95.79
|
Same |
|
IN
|
Base Rate |
$95.79
|
Same |
|
KS
|
Base Rate |
$95.33
|
Same |
|
KY
|
Base Rate |
$96.32
|
Same |
|
LA
|
Base Rate |
$96.31
|
Same |
|
MA
|
Base Rate |
$93.48
|
Same |
|
MD
|
Base Rate |
$93.48
|
Same |
|
ME
|
Base Rate |
$93.48
|
Same |
|
MI
|
Base Rate |
$95.79
|
Same |
|
MN
|
Base Rate |
$95.79
|
Same |
|
MO
|
Base Rate |
$95.33
|
Same |
|
MS
|
Base Rate |
$96.32
|
Same |
|
MT
|
Base Rate |
$97.02
|
Same |
|
NC
|
Base Rate |
$96.32
|
Same |
|
ND
|
Base Rate |
$97.02
|
Same |
|
NE
|
Base Rate |
$95.33
|
Same |
|
NH
|
Base Rate |
$93.48
|
Same |
|
NJ
|
Base Rate |
$93.48
|
Same |
|
NM
|
Base Rate |
$96.31
|
Same |
|
NV
|
Base Rate |
$93.48
|
Same |
|
NY
|
Base Rate |
$93.48
|
Same |
|
OH
|
Base Rate |
$95.79
|
Same |
|
OK
|
Base Rate |
$96.31
|
Same |
|
OR
|
Base Rate |
$93.48
|
Same |
|
PA
|
Base Rate |
$93.48
|
Same |
|
PR
|
Base Rate |
$102.83
|
Same |
|
RI
|
Base Rate |
$93.48
|
Same |
|
SC
|
Base Rate |
$96.32
|
Same |
|
SD
|
Base Rate |
$97.02
|
Same |
|
TN
|
Base Rate |
$96.32
|
Same |
|
TX
|
Base Rate |
$96.31
|
Same |
|
UT
|
Base Rate |
$97.02
|
Same |
|
VA
|
Base Rate |
$93.48
|
Same |
|
VI
|
Base Rate |
$102.83
|
Same |
|
VT
|
Base Rate |
$93.48
|
Same |
|
WA
|
Base Rate |
$93.48
|
Same |
|
WI
|
Base Rate |
$95.79
|
Same |
|
WV
|
Base Rate |
$93.48
|
Same |
|
WY
|
Base Rate |
$97.02
|
Same |