L3977
Prosthetics & Orthotics
53 States
Shoulder elbow wrist hand finger orthosis, shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment
Short Desc
Sewhfo cap desgn w/jnt(s) cf
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2006-01-01
National Floor
$1,881.34
National Ceiling
$2,508.46
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$2,055.53
|
Same |
|
AL
|
Base Rate |
$2,117.37
|
Same |
|
AR
|
Base Rate |
$2,117.21
|
Same |
|
AZ
|
Base Rate |
$2,055.53
|
Same |
|
CA
|
Base Rate |
$2,055.53
|
Same |
|
CO
|
Base Rate |
$2,129.07
|
Same |
|
CT
|
Base Rate |
$2,055.53
|
Same |
|
DC
|
Base Rate |
$2,055.53
|
Same |
|
DE
|
Base Rate |
$2,055.53
|
Same |
|
FL
|
Base Rate |
$2,117.37
|
Same |
|
GA
|
Base Rate |
$2,117.37
|
Same |
|
HI
|
Base Rate |
$2,055.53
|
Same |
|
IA
|
Base Rate |
$2,095.65
|
Same |
|
ID
|
Base Rate |
$2,055.53
|
Same |
|
IL
|
Base Rate |
$2,106.00
|
Same |
|
IN
|
Base Rate |
$2,106.00
|
Same |
|
KS
|
Base Rate |
$2,095.65
|
Same |
|
KY
|
Base Rate |
$2,117.37
|
Same |
|
LA
|
Base Rate |
$2,117.21
|
Same |
|
MA
|
Base Rate |
$2,055.53
|
Same |
|
MD
|
Base Rate |
$2,055.53
|
Same |
|
ME
|
Base Rate |
$2,055.53
|
Same |
|
MI
|
Base Rate |
$2,106.00
|
Same |
|
MN
|
Base Rate |
$2,106.00
|
Same |
|
MO
|
Base Rate |
$2,095.65
|
Same |
|
MS
|
Base Rate |
$2,117.37
|
Same |
|
MT
|
Base Rate |
$2,129.07
|
Same |
|
NC
|
Base Rate |
$2,117.37
|
Same |
|
ND
|
Base Rate |
$2,129.07
|
Same |
|
NE
|
Base Rate |
$2,095.65
|
Same |
|
NH
|
Base Rate |
$2,055.53
|
Same |
|
NJ
|
Base Rate |
$2,055.53
|
Same |
|
NM
|
Base Rate |
$2,117.21
|
Same |
|
NV
|
Base Rate |
$2,055.53
|
Same |
|
NY
|
Base Rate |
$2,055.53
|
Same |
|
OH
|
Base Rate |
$2,106.00
|
Same |
|
OK
|
Base Rate |
$2,117.21
|
Same |
|
OR
|
Base Rate |
$2,055.53
|
Same |
|
PA
|
Base Rate |
$2,055.53
|
Same |
|
PR
|
Base Rate |
$2,261.06
|
Same |
|
RI
|
Base Rate |
$2,055.53
|
Same |
|
SC
|
Base Rate |
$2,117.37
|
Same |
|
SD
|
Base Rate |
$2,129.07
|
Same |
|
TN
|
Base Rate |
$2,117.37
|
Same |
|
TX
|
Base Rate |
$2,117.21
|
Same |
|
UT
|
Base Rate |
$2,129.07
|
Same |
|
VA
|
Base Rate |
$2,055.53
|
Same |
|
VI
|
Base Rate |
$2,261.06
|
Same |
|
VT
|
Base Rate |
$2,055.53
|
Same |
|
WA
|
Base Rate |
$2,055.53
|
Same |
|
WI
|
Base Rate |
$2,106.00
|
Same |
|
WV
|
Base Rate |
$2,055.53
|
Same |
|
WY
|
Base Rate |
$2,129.07
|
Same |