L4396
Prosthetics & Orthotics
53 States
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
Short Desc
Static or dynami afo pre cst
Coverage determined by local carrier discretion.
Added Date
1997-01-01
Effective From
2014-01-01
National Floor
$183.91
National Ceiling
$245.21
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$197.90
|
Same |
|
AL
|
Base Rate |
$207.41
|
Same |
|
AR
|
Base Rate |
$207.40
|
Same |
|
AZ
|
Base Rate |
$197.90
|
Same |
|
CA
|
Base Rate |
$197.90
|
Same |
|
CO
|
Base Rate |
$204.74
|
Same |
|
CT
|
Base Rate |
$210.28
|
Same |
|
DC
|
Base Rate |
$201.26
|
Same |
|
DE
|
Base Rate |
$201.26
|
Same |
|
FL
|
Base Rate |
$207.41
|
Same |
|
GA
|
Base Rate |
$207.41
|
Same |
|
HI
|
Base Rate |
$197.90
|
Same |
|
IA
|
Base Rate |
$197.90
|
Same |
|
ID
|
Base Rate |
$197.90
|
Same |
|
IL
|
Base Rate |
$206.23
|
Same |
|
IN
|
Base Rate |
$206.23
|
Same |
|
KS
|
Base Rate |
$197.90
|
Same |
|
KY
|
Base Rate |
$207.41
|
Same |
|
LA
|
Base Rate |
$207.40
|
Same |
|
MA
|
Base Rate |
$210.28
|
Same |
|
MD
|
Base Rate |
$201.26
|
Same |
|
ME
|
Base Rate |
$210.28
|
Same |
|
MI
|
Base Rate |
$206.23
|
Same |
|
MN
|
Base Rate |
$206.23
|
Same |
|
MO
|
Base Rate |
$197.90
|
Same |
|
MS
|
Base Rate |
$207.41
|
Same |
|
MT
|
Base Rate |
$204.74
|
Same |
|
NC
|
Base Rate |
$207.41
|
Same |
|
ND
|
Base Rate |
$204.74
|
Same |
|
NE
|
Base Rate |
$197.90
|
Same |
|
NH
|
Base Rate |
$210.28
|
Same |
|
NJ
|
Base Rate |
$201.26
|
Same |
|
NM
|
Base Rate |
$207.40
|
Same |
|
NV
|
Base Rate |
$197.90
|
Same |
|
NY
|
Base Rate |
$201.26
|
Same |
|
OH
|
Base Rate |
$206.23
|
Same |
|
OK
|
Base Rate |
$207.40
|
Same |
|
OR
|
Base Rate |
$197.90
|
Same |
|
PA
|
Base Rate |
$201.26
|
Same |
|
PR
|
Base Rate |
$241.56
|
Same |
|
RI
|
Base Rate |
$210.28
|
Same |
|
SC
|
Base Rate |
$207.41
|
Same |
|
SD
|
Base Rate |
$204.74
|
Same |
|
TN
|
Base Rate |
$207.41
|
Same |
|
TX
|
Base Rate |
$207.40
|
Same |
|
UT
|
Base Rate |
$204.74
|
Same |
|
VA
|
Base Rate |
$201.26
|
Same |
|
VI
|
Base Rate |
$201.26
|
Same |
|
VT
|
Base Rate |
$210.28
|
Same |
|
WA
|
Base Rate |
$197.90
|
Same |
|
WI
|
Base Rate |
$206.23
|
Same |
|
WV
|
Base Rate |
$201.26
|
Same |
|
WY
|
Base Rate |
$204.74
|
Same |