L3915
Prosthetics & Orthotics
53 States
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Short Desc
Who nontorsion jnts pre cst
Coverage determined by local carrier discretion.
Added Date
2007-01-01
Effective From
2014-01-01
National Floor
$531.12
National Ceiling
$708.16
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$580.28
|
Same |
|
AL
|
Base Rate |
$597.78
|
Same |
|
AR
|
Base Rate |
$597.72
|
Same |
|
AZ
|
Base Rate |
$580.28
|
Same |
|
CA
|
Base Rate |
$580.28
|
Same |
|
CO
|
Base Rate |
$601.08
|
Same |
|
CT
|
Base Rate |
$580.28
|
Same |
|
DC
|
Base Rate |
$580.28
|
Same |
|
DE
|
Base Rate |
$580.28
|
Same |
|
FL
|
Base Rate |
$597.78
|
Same |
|
GA
|
Base Rate |
$597.78
|
Same |
|
HI
|
Base Rate |
$580.28
|
Same |
|
IA
|
Base Rate |
$591.63
|
Same |
|
ID
|
Base Rate |
$580.28
|
Same |
|
IL
|
Base Rate |
$594.54
|
Same |
|
IN
|
Base Rate |
$594.54
|
Same |
|
KS
|
Base Rate |
$591.63
|
Same |
|
KY
|
Base Rate |
$597.78
|
Same |
|
LA
|
Base Rate |
$597.72
|
Same |
|
MA
|
Base Rate |
$580.28
|
Same |
|
MD
|
Base Rate |
$580.28
|
Same |
|
ME
|
Base Rate |
$580.28
|
Same |
|
MI
|
Base Rate |
$594.54
|
Same |
|
MN
|
Base Rate |
$594.54
|
Same |
|
MO
|
Base Rate |
$591.63
|
Same |
|
MS
|
Base Rate |
$597.78
|
Same |
|
MT
|
Base Rate |
$601.08
|
Same |
|
NC
|
Base Rate |
$597.78
|
Same |
|
ND
|
Base Rate |
$601.08
|
Same |
|
NE
|
Base Rate |
$591.63
|
Same |
|
NH
|
Base Rate |
$580.28
|
Same |
|
NJ
|
Base Rate |
$580.28
|
Same |
|
NM
|
Base Rate |
$597.72
|
Same |
|
NV
|
Base Rate |
$580.28
|
Same |
|
NY
|
Base Rate |
$580.28
|
Same |
|
OH
|
Base Rate |
$594.54
|
Same |
|
OK
|
Base Rate |
$597.72
|
Same |
|
OR
|
Base Rate |
$580.28
|
Same |
|
PA
|
Base Rate |
$580.28
|
Same |
|
PR
|
Base Rate |
$638.37
|
Same |
|
RI
|
Base Rate |
$580.28
|
Same |
|
SC
|
Base Rate |
$597.78
|
Same |
|
SD
|
Base Rate |
$601.08
|
Same |
|
TN
|
Base Rate |
$597.78
|
Same |
|
TX
|
Base Rate |
$597.72
|
Same |
|
UT
|
Base Rate |
$601.08
|
Same |
|
VA
|
Base Rate |
$580.28
|
Same |
|
VI
|
Base Rate |
$638.37
|
Same |
|
VT
|
Base Rate |
$580.28
|
Same |
|
WA
|
Base Rate |
$580.28
|
Same |
|
WI
|
Base Rate |
$594.54
|
Same |
|
WV
|
Base Rate |
$580.28
|
Same |
|
WY
|
Base Rate |
$601.08
|
Same |