L4631
Prosthetics & Orthotics
53 States
Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated
Short Desc
Afo, walk boot type, cus fab
Coverage determined by local carrier discretion.
Added Date
2011-01-01
Effective From
2011-01-01
National Floor
$1,693.18
National Ceiling
$2,257.57
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$2,412.72
|
Same |
|
AL
|
Base Rate |
$1,843.94
|
Same |
|
AR
|
Base Rate |
$1,827.50
|
Same |
|
AZ
|
Base Rate |
$2,257.57
|
Same |
|
CA
|
Base Rate |
$2,257.57
|
Same |
|
CO
|
Base Rate |
$1,710.05
|
Same |
|
CT
|
Base Rate |
$1,967.57
|
Same |
|
DC
|
Base Rate |
$1,912.64
|
Same |
|
DE
|
Base Rate |
$1,912.64
|
Same |
|
FL
|
Base Rate |
$1,843.94
|
Same |
|
GA
|
Base Rate |
$1,843.94
|
Same |
|
HI
|
Base Rate |
$2,542.49
|
Same |
|
IA
|
Base Rate |
$1,760.00
|
Same |
|
ID
|
Base Rate |
$1,834.95
|
Same |
|
IL
|
Base Rate |
$1,811.67
|
Same |
|
IN
|
Base Rate |
$1,811.67
|
Same |
|
KS
|
Base Rate |
$1,760.00
|
Same |
|
KY
|
Base Rate |
$1,843.94
|
Same |
|
LA
|
Base Rate |
$1,827.50
|
Same |
|
MA
|
Base Rate |
$1,967.57
|
Same |
|
MD
|
Base Rate |
$1,912.64
|
Same |
|
ME
|
Base Rate |
$1,967.57
|
Same |
|
MI
|
Base Rate |
$1,811.67
|
Same |
|
MN
|
Base Rate |
$1,811.67
|
Same |
|
MO
|
Base Rate |
$1,760.00
|
Same |
|
MS
|
Base Rate |
$1,843.94
|
Same |
|
MT
|
Base Rate |
$1,710.05
|
Same |
|
NC
|
Base Rate |
$1,843.94
|
Same |
|
ND
|
Base Rate |
$1,710.05
|
Same |
|
NE
|
Base Rate |
$1,760.00
|
Same |
|
NH
|
Base Rate |
$1,967.57
|
Same |
|
NJ
|
Base Rate |
$2,160.48
|
Same |
|
NM
|
Base Rate |
$1,827.50
|
Same |
|
NV
|
Base Rate |
$2,257.57
|
Same |
|
NY
|
Base Rate |
$2,160.48
|
Same |
|
OH
|
Base Rate |
$1,811.67
|
Same |
|
OK
|
Base Rate |
$1,827.50
|
Same |
|
OR
|
Base Rate |
$1,834.95
|
Same |
|
PA
|
Base Rate |
$1,912.64
|
Same |
|
PR
|
Base Rate |
$3,027.97
|
Same |
|
RI
|
Base Rate |
$1,967.57
|
Same |
|
SC
|
Base Rate |
$1,843.94
|
Same |
|
SD
|
Base Rate |
$1,710.05
|
Same |
|
TN
|
Base Rate |
$1,843.94
|
Same |
|
TX
|
Base Rate |
$1,827.50
|
Same |
|
UT
|
Base Rate |
$1,710.05
|
Same |
|
VA
|
Base Rate |
$1,912.64
|
Same |
|
VI
|
Base Rate |
$2,181.33
|
Same |
|
VT
|
Base Rate |
$1,967.57
|
Same |
|
WA
|
Base Rate |
$1,834.95
|
Same |
|
WI
|
Base Rate |
$1,811.67
|
Same |
|
WV
|
Base Rate |
$1,912.64
|
Same |
|
WY
|
Base Rate |
$1,710.05
|
Same |