L0639
Prosthetics & Orthotics
53 States
Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, 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 s/c shell/panel prefab
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2014-01-01
National Floor
$1,288.60
National Ceiling
$1,718.13
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,487.04
|
Same |
|
AL
|
Base Rate |
$1,682.10
|
Same |
|
AR
|
Base Rate |
$1,501.02
|
Same |
|
AZ
|
Base Rate |
$1,451.22
|
Same |
|
CA
|
Base Rate |
$1,451.22
|
Same |
|
CO
|
Base Rate |
$1,288.60
|
Same |
|
CT
|
Base Rate |
$1,404.53
|
Same |
|
DC
|
Base Rate |
$1,288.60
|
Same |
|
DE
|
Base Rate |
$1,288.60
|
Same |
|
FL
|
Base Rate |
$1,682.10
|
Same |
|
GA
|
Base Rate |
$1,682.10
|
Same |
|
HI
|
Base Rate |
$1,590.09
|
Same |
|
IA
|
Base Rate |
$1,456.55
|
Same |
|
ID
|
Base Rate |
$1,348.20
|
Same |
|
IL
|
Base Rate |
$1,592.13
|
Same |
|
IN
|
Base Rate |
$1,592.13
|
Same |
|
KS
|
Base Rate |
$1,456.55
|
Same |
|
KY
|
Base Rate |
$1,682.10
|
Same |
|
LA
|
Base Rate |
$1,501.02
|
Same |
|
MA
|
Base Rate |
$1,404.53
|
Same |
|
MD
|
Base Rate |
$1,288.60
|
Same |
|
ME
|
Base Rate |
$1,404.53
|
Same |
|
MI
|
Base Rate |
$1,592.13
|
Same |
|
MN
|
Base Rate |
$1,592.13
|
Same |
|
MO
|
Base Rate |
$1,456.55
|
Same |
|
MS
|
Base Rate |
$1,682.10
|
Same |
|
MT
|
Base Rate |
$1,288.60
|
Same |
|
NC
|
Base Rate |
$1,682.10
|
Same |
|
ND
|
Base Rate |
$1,288.60
|
Same |
|
NE
|
Base Rate |
$1,456.55
|
Same |
|
NH
|
Base Rate |
$1,404.53
|
Same |
|
NJ
|
Base Rate |
$1,288.60
|
Same |
|
NM
|
Base Rate |
$1,501.02
|
Same |
|
NV
|
Base Rate |
$1,451.22
|
Same |
|
NY
|
Base Rate |
$1,288.60
|
Same |
|
OH
|
Base Rate |
$1,592.13
|
Same |
|
OK
|
Base Rate |
$1,501.02
|
Same |
|
OR
|
Base Rate |
$1,348.20
|
Same |
|
PA
|
Base Rate |
$1,288.60
|
Same |
|
PR
|
Base Rate |
$1,427.66
|
Same |
|
RI
|
Base Rate |
$1,404.53
|
Same |
|
SC
|
Base Rate |
$1,682.10
|
Same |
|
SD
|
Base Rate |
$1,288.60
|
Same |
|
TN
|
Base Rate |
$1,682.10
|
Same |
|
TX
|
Base Rate |
$1,501.02
|
Same |
|
UT
|
Base Rate |
$1,288.60
|
Same |
|
VA
|
Base Rate |
$1,288.60
|
Same |
|
VI
|
Base Rate |
$1,288.60
|
Same |
|
VT
|
Base Rate |
$1,404.53
|
Same |
|
WA
|
Base Rate |
$1,348.20
|
Same |
|
WI
|
Base Rate |
$1,592.13
|
Same |
|
WV
|
Base Rate |
$1,288.60
|
Same |
|
WY
|
Base Rate |
$1,288.60
|
Same |