L0633
Prosthetics & Orthotics
53 States
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on 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
Lso sc r pos/lat pnl pre cst
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2014-01-01
National Floor
$314.90
National Ceiling
$419.87
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$343.97
|
Same |
|
AL
|
Base Rate |
$354.33
|
Same |
|
AR
|
Base Rate |
$354.31
|
Same |
|
AZ
|
Base Rate |
$343.97
|
Same |
|
CA
|
Base Rate |
$343.97
|
Same |
|
CO
|
Base Rate |
$356.98
|
Same |
|
CT
|
Base Rate |
$343.97
|
Same |
|
DC
|
Base Rate |
$343.97
|
Same |
|
DE
|
Base Rate |
$343.97
|
Same |
|
FL
|
Base Rate |
$354.33
|
Same |
|
GA
|
Base Rate |
$354.33
|
Same |
|
HI
|
Base Rate |
$343.97
|
Same |
|
IA
|
Base Rate |
$350.67
|
Same |
|
ID
|
Base Rate |
$343.97
|
Same |
|
IL
|
Base Rate |
$352.41
|
Same |
|
IN
|
Base Rate |
$352.41
|
Same |
|
KS
|
Base Rate |
$350.67
|
Same |
|
KY
|
Base Rate |
$354.33
|
Same |
|
LA
|
Base Rate |
$354.31
|
Same |
|
MA
|
Base Rate |
$343.97
|
Same |
|
MD
|
Base Rate |
$343.97
|
Same |
|
ME
|
Base Rate |
$343.97
|
Same |
|
MI
|
Base Rate |
$352.41
|
Same |
|
MN
|
Base Rate |
$352.41
|
Same |
|
MO
|
Base Rate |
$350.67
|
Same |
|
MS
|
Base Rate |
$354.33
|
Same |
|
MT
|
Base Rate |
$356.98
|
Same |
|
NC
|
Base Rate |
$354.33
|
Same |
|
ND
|
Base Rate |
$356.98
|
Same |
|
NE
|
Base Rate |
$350.67
|
Same |
|
NH
|
Base Rate |
$343.97
|
Same |
|
NJ
|
Base Rate |
$343.97
|
Same |
|
NM
|
Base Rate |
$354.31
|
Same |
|
NV
|
Base Rate |
$343.97
|
Same |
|
NY
|
Base Rate |
$343.97
|
Same |
|
OH
|
Base Rate |
$352.41
|
Same |
|
OK
|
Base Rate |
$354.31
|
Same |
|
OR
|
Base Rate |
$343.97
|
Same |
|
PA
|
Base Rate |
$343.97
|
Same |
|
PR
|
Base Rate |
$378.33
|
Same |
|
RI
|
Base Rate |
$343.97
|
Same |
|
SC
|
Base Rate |
$354.33
|
Same |
|
SD
|
Base Rate |
$356.98
|
Same |
|
TN
|
Base Rate |
$354.33
|
Same |
|
TX
|
Base Rate |
$354.31
|
Same |
|
UT
|
Base Rate |
$356.98
|
Same |
|
VA
|
Base Rate |
$343.97
|
Same |
|
VI
|
Base Rate |
$378.33
|
Same |
|
VT
|
Base Rate |
$343.97
|
Same |
|
WA
|
Base Rate |
$343.97
|
Same |
|
WI
|
Base Rate |
$352.41
|
Same |
|
WV
|
Base Rate |
$343.97
|
Same |
|
WY
|
Base Rate |
$356.98
|
Same |