L1653
Prosthetics & Orthotics
53 States
Hip orthosis, bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, off the shelf
Short Desc
Ho abduction static ots
Coverage determined by local carrier discretion.
Added Date
2024-10-01
Effective From
2024-10-01
National Floor
$391.35
National Ceiling
$521.80
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$427.56
|
Same |
|
AL
|
Base Rate |
$440.48
|
Same |
|
AR
|
Base Rate |
$440.44
|
Same |
|
AZ
|
Base Rate |
$427.56
|
Same |
|
CA
|
Base Rate |
$427.56
|
Same |
|
CO
|
Base Rate |
$442.89
|
Same |
|
CT
|
Base Rate |
$427.56
|
Same |
|
DC
|
Base Rate |
$427.56
|
Same |
|
DE
|
Base Rate |
$427.56
|
Same |
|
FL
|
Base Rate |
$440.48
|
Same |
|
GA
|
Base Rate |
$440.48
|
Same |
|
HI
|
Base Rate |
$427.56
|
Same |
|
IA
|
Base Rate |
$435.97
|
Same |
|
ID
|
Base Rate |
$427.56
|
Same |
|
IL
|
Base Rate |
$438.09
|
Same |
|
IN
|
Base Rate |
$438.09
|
Same |
|
KS
|
Base Rate |
$435.97
|
Same |
|
KY
|
Base Rate |
$440.48
|
Same |
|
LA
|
Base Rate |
$440.44
|
Same |
|
MA
|
Base Rate |
$427.56
|
Same |
|
MD
|
Base Rate |
$427.56
|
Same |
|
ME
|
Base Rate |
$427.56
|
Same |
|
MI
|
Base Rate |
$438.09
|
Same |
|
MN
|
Base Rate |
$438.09
|
Same |
|
MO
|
Base Rate |
$435.97
|
Same |
|
MS
|
Base Rate |
$440.48
|
Same |
|
MT
|
Base Rate |
$442.89
|
Same |
|
NC
|
Base Rate |
$440.48
|
Same |
|
ND
|
Base Rate |
$442.89
|
Same |
|
NE
|
Base Rate |
$435.97
|
Same |
|
NH
|
Base Rate |
$427.56
|
Same |
|
NJ
|
Base Rate |
$427.56
|
Same |
|
NM
|
Base Rate |
$440.44
|
Same |
|
NV
|
Base Rate |
$427.56
|
Same |
|
NY
|
Base Rate |
$427.56
|
Same |
|
OH
|
Base Rate |
$438.09
|
Same |
|
OK
|
Base Rate |
$440.44
|
Same |
|
OR
|
Base Rate |
$427.56
|
Same |
|
PA
|
Base Rate |
$427.56
|
Same |
|
PR
|
Base Rate |
$470.32
|
Same |
|
RI
|
Base Rate |
$427.56
|
Same |
|
SC
|
Base Rate |
$440.48
|
Same |
|
SD
|
Base Rate |
$442.89
|
Same |
|
TN
|
Base Rate |
$440.48
|
Same |
|
TX
|
Base Rate |
$440.44
|
Same |
|
UT
|
Base Rate |
$442.89
|
Same |
|
VA
|
Base Rate |
$427.56
|
Same |
|
VI
|
Base Rate |
$470.32
|
Same |
|
VT
|
Base Rate |
$427.56
|
Same |
|
WA
|
Base Rate |
$427.56
|
Same |
|
WI
|
Base Rate |
$438.09
|
Same |
|
WV
|
Base Rate |
$427.56
|
Same |
|
WY
|
Base Rate |
$442.89
|
Same |