Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf

Short Desc Ko immob canvas long pre ots

Coverage determined by local carrier discretion.

Added Date

1986-01-01

Effective From

2014-01-01

Fee Schedule Rates

Effective Jan 2026

Official Medicare DMEPOS pricing for 2026.

Showing Non-Rural and Rural rates.

State	Modifier	Non-Rural	Rural
AK Alaska	Base Rate	$142.71	Same
AL Alabama	Base Rate	$77.23	$100.93
AR Arkansas	Base Rate	$77.23	$88.88
AZ Arizona	Base Rate	$63.18	$105.63
CA California	Base Rate	$63.18	$105.63
CO Colorado	Base Rate	$64.38	$91.69
CT Connecticut	Base Rate	$74.79	$88.88
DC District Of Columbia	Base Rate	$69.94	$91.93
DE Delaware	Base Rate	$69.94	$91.93
FL Florida	Base Rate	$77.23	$100.93
GA Georgia	Base Rate	$77.23	$100.93
HI Hawaii	Base Rate	$149.93	Same
IA Iowa	Base Rate	$69.69	$90.97
ID Idaho	Base Rate	$64.38	$102.85
IL Illinois	Base Rate	$70.75	$89.73
IN Indiana	Base Rate	$70.75	$89.73
KS Kansas	Base Rate	$69.69	$90.97
KY Kentucky	Base Rate	$77.23	$100.93
LA Louisiana	Base Rate	$77.23	$88.88
MA Massachusetts	Base Rate	$74.79	$88.88
MD Maryland	Base Rate	$69.94	$91.93
ME Maine	Base Rate	$74.79	$88.88
MI Michigan	Base Rate	$70.75	$89.73
MN Minnesota	Base Rate	$69.69	$89.73
MO Missouri	Base Rate	$69.69	$90.97
MS Mississippi	Base Rate	$77.23	$100.93
MT Montana	Base Rate	$64.38	$91.69
NC North Carolina	Base Rate	$77.23	$100.93
ND North Dakota	Base Rate	$69.69	$91.69
NE Nebraska	Base Rate	$69.69	$90.97
NH New Hampshire	Base Rate	$74.79	$88.88
NJ New Jersey	Base Rate	$69.94	$98.20
NM New Mexico	Base Rate	$63.18	$88.88
NV Nevada	Base Rate	$63.18	$105.63
NY New York	Base Rate	$69.94	$98.20
OH Ohio	Base Rate	$70.75	$89.73
OK Oklahoma	Base Rate	$63.18	$88.88
OR Oregon	Base Rate	$63.18	$102.85
PA Pennsylvania	Base Rate	$69.94	$91.93
PR Puerto Rico	Base Rate	$102.48	Same
RI Rhode Island	Base Rate	$74.79	$88.88
SC South Carolina	Base Rate	$77.23	$100.93
SD South Dakota	Base Rate	$69.69	$91.69
TN Tennessee	Base Rate	$77.23	$100.93
TX Texas	Base Rate	$63.18	$88.88
UT Utah	Base Rate	$64.38	$91.69
VA Virginia	Base Rate	$77.23	$91.93
VI Virgin Islands	Base Rate	$98.20	Same
VT Vermont	Base Rate	$74.79	$88.88
WA Washington	Base Rate	$63.18	$102.85
WI Wisconsin	Base Rate	$70.75	$89.73
WV West Virginia	Base Rate	$77.23	$91.93
WY Wyoming	Base Rate	$64.38	$91.69