L1852
Prosthetics & Orthotics
53 States
Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf
Short Desc
Ko double upright prefab ots
Coverage determined by local carrier discretion.
Added Date
2017-01-01
Effective From
2017-01-01
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$830.33
|
Same |
|
AL
|
Base Rate |
$700.49
|
$928.91
|
|
AR
|
Base Rate |
$700.49
|
$888.40
|
|
AZ
|
Base Rate |
$573.13
|
$819.86
|
|
CA
|
Base Rate |
$573.13
|
$819.86
|
|
CO
|
Base Rate |
$583.90
|
$835.27
|
|
CT
|
Base Rate |
$678.38
|
$850.63
|
|
DC
|
Base Rate |
$634.46
|
$908.68
|
|
DE
|
Base Rate |
$634.46
|
$908.68
|
|
FL
|
Base Rate |
$700.49
|
$928.91
|
|
GA
|
Base Rate |
$700.49
|
$928.91
|
|
HI
|
Base Rate |
$863.62
|
Same |
|
IA
|
Base Rate |
$632.13
|
$819.86
|
|
ID
|
Base Rate |
$583.90
|
$837.96
|
|
IL
|
Base Rate |
$641.72
|
$864.98
|
|
IN
|
Base Rate |
$641.72
|
$864.98
|
|
KS
|
Base Rate |
$632.13
|
$819.86
|
|
KY
|
Base Rate |
$700.49
|
$928.91
|
|
LA
|
Base Rate |
$700.49
|
$888.40
|
|
MA
|
Base Rate |
$678.38
|
$850.63
|
|
MD
|
Base Rate |
$634.46
|
$908.68
|
|
ME
|
Base Rate |
$678.38
|
$850.63
|
|
MI
|
Base Rate |
$641.72
|
$864.98
|
|
MN
|
Base Rate |
$632.13
|
$864.98
|
|
MO
|
Base Rate |
$632.13
|
$819.86
|
|
MS
|
Base Rate |
$700.49
|
$928.91
|
|
MT
|
Base Rate |
$583.90
|
$835.27
|
|
NC
|
Base Rate |
$700.49
|
$928.91
|
|
ND
|
Base Rate |
$632.13
|
$835.27
|
|
NE
|
Base Rate |
$632.13
|
$819.86
|
|
NH
|
Base Rate |
$678.38
|
$850.63
|
|
NJ
|
Base Rate |
$634.46
|
$940.49
|
|
NM
|
Base Rate |
$573.13
|
$888.40
|
|
NV
|
Base Rate |
$573.13
|
$819.86
|
|
NY
|
Base Rate |
$634.46
|
$940.49
|
|
OH
|
Base Rate |
$641.72
|
$864.98
|
|
OK
|
Base Rate |
$573.13
|
$888.40
|
|
OR
|
Base Rate |
$573.13
|
$837.96
|
|
PA
|
Base Rate |
$634.46
|
$908.68
|
|
PR
|
Base Rate |
$902.28
|
Same |
|
RI
|
Base Rate |
$678.38
|
$850.63
|
|
SC
|
Base Rate |
$700.49
|
$928.91
|
|
SD
|
Base Rate |
$632.13
|
$835.27
|
|
TN
|
Base Rate |
$700.49
|
$928.91
|
|
TX
|
Base Rate |
$573.13
|
$888.40
|
|
UT
|
Base Rate |
$583.90
|
$835.27
|
|
VA
|
Base Rate |
$700.49
|
$908.68
|
|
VI
|
Base Rate |
$940.49
|
Same |
|
VT
|
Base Rate |
$678.38
|
$850.63
|
|
WA
|
Base Rate |
$573.13
|
$837.96
|
|
WI
|
Base Rate |
$641.72
|
$864.98
|
|
WV
|
Base Rate |
$700.49
|
$908.68
|
|
WY
|
Base Rate |
$583.90
|
$835.27
|