L0641
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, off-the-shelf
Short Desc
Lo rig pos pnl l1-l5 pre ots
Coverage determined by local carrier discretion.
Added Date
2014-01-01
Effective From
2014-01-01
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$89.10
|
Same |
|
AL
|
Base Rate |
$60.55
|
$78.44
|
|
AR
|
Base Rate |
$60.55
|
$78.43
|
|
AZ
|
Base Rate |
$57.10
|
$77.02
|
|
CA
|
Base Rate |
$26.67
|
$77.02
|
|
CO
|
Base Rate |
$39.75
|
$78.79
|
|
CT
|
Base Rate |
$60.55
|
$77.02
|
|
DC
|
Base Rate |
$53.13
|
$77.02
|
|
DE
|
Base Rate |
$53.13
|
$77.02
|
|
FL
|
Base Rate |
$60.55
|
$78.44
|
|
GA
|
Base Rate |
$60.55
|
$78.44
|
|
HI
|
Base Rate |
$89.10
|
Same |
|
IA
|
Base Rate |
$59.36
|
$77.94
|
|
ID
|
Base Rate |
$39.75
|
$77.02
|
|
IL
|
Base Rate |
$51.40
|
$78.17
|
|
IN
|
Base Rate |
$51.40
|
$78.17
|
|
KS
|
Base Rate |
$59.36
|
$77.94
|
|
KY
|
Base Rate |
$60.55
|
$78.44
|
|
LA
|
Base Rate |
$60.55
|
$78.43
|
|
MA
|
Base Rate |
$60.55
|
$77.02
|
|
MD
|
Base Rate |
$53.13
|
$77.02
|
|
ME
|
Base Rate |
$60.55
|
$77.02
|
|
MI
|
Base Rate |
$51.40
|
$78.17
|
|
MN
|
Base Rate |
$59.36
|
$78.17
|
|
MO
|
Base Rate |
$59.36
|
$77.94
|
|
MS
|
Base Rate |
$60.55
|
$78.44
|
|
MT
|
Base Rate |
$39.75
|
$78.79
|
|
NC
|
Base Rate |
$60.55
|
$78.44
|
|
ND
|
Base Rate |
$59.36
|
$78.79
|
|
NE
|
Base Rate |
$59.36
|
$77.94
|
|
NH
|
Base Rate |
$60.55
|
$77.02
|
|
NJ
|
Base Rate |
$53.13
|
$77.02
|
|
NM
|
Base Rate |
$57.10
|
$78.43
|
|
NV
|
Base Rate |
$26.67
|
$77.02
|
|
NY
|
Base Rate |
$53.13
|
$77.02
|
|
OH
|
Base Rate |
$51.40
|
$78.17
|
|
OK
|
Base Rate |
$57.10
|
$78.43
|
|
OR
|
Base Rate |
$26.67
|
$77.02
|
|
PA
|
Base Rate |
$53.13
|
$77.02
|
|
PR
|
Base Rate |
$93.77
|
Same |
|
RI
|
Base Rate |
$60.55
|
$77.02
|
|
SC
|
Base Rate |
$60.55
|
$78.44
|
|
SD
|
Base Rate |
$59.36
|
$78.79
|
|
TN
|
Base Rate |
$60.55
|
$78.44
|
|
TX
|
Base Rate |
$57.10
|
$78.43
|
|
UT
|
Base Rate |
$39.75
|
$78.79
|
|
VA
|
Base Rate |
$60.55
|
$77.02
|
|
VI
|
Base Rate |
$93.77
|
Same |
|
VT
|
Base Rate |
$60.55
|
$77.02
|
|
WA
|
Base Rate |
$26.67
|
$77.02
|
|
WI
|
Base Rate |
$51.40
|
$78.17
|
|
WV
|
Base Rate |
$60.55
|
$77.02
|
|
WY
|
Base Rate |
$39.75
|
$78.79
|