L2387
Prosthetics & Orthotics
53 States
Addition to lower extremity, polycentric knee joint, for custom fabricated knee ankle foot orthosis, each joint
Short Desc
Add le poly knee custom kafo
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2006-01-01
National Floor
$190.18
National Ceiling
$253.57
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$272.72
|
Same |
|
AL
|
Base Rate |
$208.88
|
Same |
|
AR
|
Base Rate |
$190.18
|
Same |
|
AZ
|
Base Rate |
$253.57
|
Same |
|
CA
|
Base Rate |
$253.57
|
Same |
|
CO
|
Base Rate |
$190.18
|
Same |
|
CT
|
Base Rate |
$253.57
|
Same |
|
DC
|
Base Rate |
$221.76
|
Same |
|
DE
|
Base Rate |
$221.76
|
Same |
|
FL
|
Base Rate |
$208.88
|
Same |
|
GA
|
Base Rate |
$208.88
|
Same |
|
HI
|
Base Rate |
$291.68
|
Same |
|
IA
|
Base Rate |
$190.18
|
Same |
|
ID
|
Base Rate |
$233.37
|
Same |
|
IL
|
Base Rate |
$234.60
|
Same |
|
IN
|
Base Rate |
$234.60
|
Same |
|
KS
|
Base Rate |
$190.18
|
Same |
|
KY
|
Base Rate |
$208.88
|
Same |
|
LA
|
Base Rate |
$190.18
|
Same |
|
MA
|
Base Rate |
$253.57
|
Same |
|
MD
|
Base Rate |
$221.76
|
Same |
|
ME
|
Base Rate |
$253.57
|
Same |
|
MI
|
Base Rate |
$234.60
|
Same |
|
MN
|
Base Rate |
$234.60
|
Same |
|
MO
|
Base Rate |
$190.18
|
Same |
|
MS
|
Base Rate |
$208.88
|
Same |
|
MT
|
Base Rate |
$190.18
|
Same |
|
NC
|
Base Rate |
$208.88
|
Same |
|
ND
|
Base Rate |
$190.18
|
Same |
|
NE
|
Base Rate |
$190.18
|
Same |
|
NH
|
Base Rate |
$253.57
|
Same |
|
NJ
|
Base Rate |
$190.18
|
Same |
|
NM
|
Base Rate |
$190.18
|
Same |
|
NV
|
Base Rate |
$253.57
|
Same |
|
NY
|
Base Rate |
$190.18
|
Same |
|
OH
|
Base Rate |
$234.60
|
Same |
|
OK
|
Base Rate |
$190.18
|
Same |
|
OR
|
Base Rate |
$233.37
|
Same |
|
PA
|
Base Rate |
$221.76
|
Same |
|
PR
|
Base Rate |
$81.66
|
Same |
|
RI
|
Base Rate |
$253.57
|
Same |
|
SC
|
Base Rate |
$208.88
|
Same |
|
SD
|
Base Rate |
$190.18
|
Same |
|
TN
|
Base Rate |
$208.88
|
Same |
|
TX
|
Base Rate |
$190.18
|
Same |
|
UT
|
Base Rate |
$190.18
|
Same |
|
VA
|
Base Rate |
$221.76
|
Same |
|
VI
|
Base Rate |
$190.18
|
Same |
|
VT
|
Base Rate |
$253.57
|
Same |
|
WA
|
Base Rate |
$233.37
|
Same |
|
WI
|
Base Rate |
$234.60
|
Same |
|
WV
|
Base Rate |
$221.76
|
Same |
|
WY
|
Base Rate |
$190.18
|
Same |