L3962
Prosthetics & Orthotics
53 States
Shoulder elbow wrist hand orthosis, abduction positioning, erb's palsey design, prefabricated, includes fitting and adjustment
Short Desc
Sewho erbs palsey design abd
Coverage determined by local carrier discretion.
Added Date
1982-01-01
Effective From
2001-01-01
National Floor
$806.80
National Ceiling
$1,075.74
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,090.01
|
Same |
|
AL
|
Base Rate |
$965.12
|
Same |
|
AR
|
Base Rate |
$806.80
|
Same |
|
AZ
|
Base Rate |
$1,075.74
|
Same |
|
CA
|
Base Rate |
$1,075.74
|
Same |
|
CO
|
Base Rate |
$806.80
|
Same |
|
CT
|
Base Rate |
$1,075.74
|
Same |
|
DC
|
Base Rate |
$806.80
|
Same |
|
DE
|
Base Rate |
$806.80
|
Same |
|
FL
|
Base Rate |
$965.12
|
Same |
|
GA
|
Base Rate |
$965.12
|
Same |
|
HI
|
Base Rate |
$1,165.56
|
Same |
|
IA
|
Base Rate |
$941.73
|
Same |
|
ID
|
Base Rate |
$1,004.17
|
Same |
|
IL
|
Base Rate |
$806.80
|
Same |
|
IN
|
Base Rate |
$806.80
|
Same |
|
KS
|
Base Rate |
$941.73
|
Same |
|
KY
|
Base Rate |
$965.12
|
Same |
|
LA
|
Base Rate |
$806.80
|
Same |
|
MA
|
Base Rate |
$1,075.74
|
Same |
|
MD
|
Base Rate |
$806.80
|
Same |
|
ME
|
Base Rate |
$1,075.74
|
Same |
|
MI
|
Base Rate |
$806.80
|
Same |
|
MN
|
Base Rate |
$806.80
|
Same |
|
MO
|
Base Rate |
$941.73
|
Same |
|
MS
|
Base Rate |
$965.12
|
Same |
|
MT
|
Base Rate |
$806.80
|
Same |
|
NC
|
Base Rate |
$965.12
|
Same |
|
ND
|
Base Rate |
$806.80
|
Same |
|
NE
|
Base Rate |
$941.73
|
Same |
|
NH
|
Base Rate |
$1,075.74
|
Same |
|
NJ
|
Base Rate |
$806.80
|
Same |
|
NM
|
Base Rate |
$806.80
|
Same |
|
NV
|
Base Rate |
$1,075.74
|
Same |
|
NY
|
Base Rate |
$806.80
|
Same |
|
OH
|
Base Rate |
$806.80
|
Same |
|
OK
|
Base Rate |
$806.80
|
Same |
|
OR
|
Base Rate |
$1,004.17
|
Same |
|
PA
|
Base Rate |
$806.80
|
Same |
|
PR
|
Base Rate |
$572.57
|
Same |
|
RI
|
Base Rate |
$1,075.74
|
Same |
|
SC
|
Base Rate |
$965.12
|
Same |
|
SD
|
Base Rate |
$806.80
|
Same |
|
TN
|
Base Rate |
$965.12
|
Same |
|
TX
|
Base Rate |
$806.80
|
Same |
|
UT
|
Base Rate |
$806.80
|
Same |
|
VA
|
Base Rate |
$806.80
|
Same |
|
VI
|
Base Rate |
$806.80
|
Same |
|
VT
|
Base Rate |
$1,075.74
|
Same |
|
WA
|
Base Rate |
$1,004.17
|
Same |
|
WI
|
Base Rate |
$806.80
|
Same |
|
WV
|
Base Rate |
$806.80
|
Same |
|
WY
|
Base Rate |
$806.80
|
Same |