L3981
Prosthetics & Orthotics
53 States
Upper extremity fracture orthosis, humeral, prefabricated, includes shoulder cap design, with or without joints, forearm section, may include soft interface, straps, includes fitting and adjustments
Short Desc
Ue fx orth shoul cap forearm
Coverage determined by local carrier discretion.
Added Date
2015-01-01
Effective From
2015-01-01
National Floor
$1,005.97
National Ceiling
$1,341.30
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,098.83
|
Same |
|
AL
|
Base Rate |
$1,131.90
|
Same |
|
AR
|
Base Rate |
$1,131.82
|
Same |
|
AZ
|
Base Rate |
$1,098.83
|
Same |
|
CA
|
Base Rate |
$1,098.83
|
Same |
|
CO
|
Base Rate |
$1,140.47
|
Same |
|
CT
|
Base Rate |
$1,098.83
|
Same |
|
DC
|
Base Rate |
$1,098.83
|
Same |
|
DE
|
Base Rate |
$1,098.83
|
Same |
|
FL
|
Base Rate |
$1,131.90
|
Same |
|
GA
|
Base Rate |
$1,131.90
|
Same |
|
HI
|
Base Rate |
$1,098.83
|
Same |
|
IA
|
Base Rate |
$1,120.27
|
Same |
|
ID
|
Base Rate |
$1,098.83
|
Same |
|
IL
|
Base Rate |
$1,125.80
|
Same |
|
IN
|
Base Rate |
$1,125.80
|
Same |
|
KS
|
Base Rate |
$1,120.27
|
Same |
|
KY
|
Base Rate |
$1,131.90
|
Same |
|
LA
|
Base Rate |
$1,131.82
|
Same |
|
MA
|
Base Rate |
$1,098.83
|
Same |
|
MD
|
Base Rate |
$1,098.83
|
Same |
|
ME
|
Base Rate |
$1,098.83
|
Same |
|
MI
|
Base Rate |
$1,125.80
|
Same |
|
MN
|
Base Rate |
$1,125.80
|
Same |
|
MO
|
Base Rate |
$1,120.27
|
Same |
|
MS
|
Base Rate |
$1,131.90
|
Same |
|
MT
|
Base Rate |
$1,140.47
|
Same |
|
NC
|
Base Rate |
$1,131.90
|
Same |
|
ND
|
Base Rate |
$1,140.47
|
Same |
|
NE
|
Base Rate |
$1,120.27
|
Same |
|
NH
|
Base Rate |
$1,098.83
|
Same |
|
NJ
|
Base Rate |
$1,098.83
|
Same |
|
NM
|
Base Rate |
$1,131.82
|
Same |
|
NV
|
Base Rate |
$1,098.83
|
Same |
|
NY
|
Base Rate |
$1,098.83
|
Same |
|
OH
|
Base Rate |
$1,125.80
|
Same |
|
OK
|
Base Rate |
$1,131.82
|
Same |
|
OR
|
Base Rate |
$1,098.83
|
Same |
|
PA
|
Base Rate |
$1,098.83
|
Same |
|
PR
|
Base Rate |
$1,208.69
|
Same |
|
RI
|
Base Rate |
$1,098.83
|
Same |
|
SC
|
Base Rate |
$1,131.90
|
Same |
|
SD
|
Base Rate |
$1,140.47
|
Same |
|
TN
|
Base Rate |
$1,131.90
|
Same |
|
TX
|
Base Rate |
$1,131.82
|
Same |
|
UT
|
Base Rate |
$1,140.47
|
Same |
|
VA
|
Base Rate |
$1,098.83
|
Same |
|
VI
|
Base Rate |
$1,208.69
|
Same |
|
VT
|
Base Rate |
$1,098.83
|
Same |
|
WA
|
Base Rate |
$1,098.83
|
Same |
|
WI
|
Base Rate |
$1,125.80
|
Same |
|
WV
|
Base Rate |
$1,098.83
|
Same |
|
WY
|
Base Rate |
$1,140.47
|
Same |