L5321
Prosthetics & Orthotics
53 States
Above knee, molded socket, open end, sach foot, endoskeletal system, single axis knee
Short Desc
Ak open end sach
Coverage determined by local carrier discretion.
Added Date
2002-01-01
Effective From
2002-01-01
National Floor
$4,023.73
National Ceiling
$5,364.98
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$6,192.89
|
Same |
|
AL
|
Base Rate |
$4,881.34
|
Same |
|
AR
|
Base Rate |
$4,710.53
|
Same |
|
AZ
|
Base Rate |
$5,364.98
|
Same |
|
CA
|
Base Rate |
$5,364.98
|
Same |
|
CO
|
Base Rate |
$4,023.73
|
Same |
|
CT
|
Base Rate |
$4,236.56
|
Same |
|
DC
|
Base Rate |
$4,023.73
|
Same |
|
DE
|
Base Rate |
$4,023.73
|
Same |
|
FL
|
Base Rate |
$4,881.34
|
Same |
|
GA
|
Base Rate |
$4,881.34
|
Same |
|
HI
|
Base Rate |
$6,709.86
|
Same |
|
IA
|
Base Rate |
$4,023.73
|
Same |
|
ID
|
Base Rate |
$5,298.50
|
Same |
|
IL
|
Base Rate |
$4,399.13
|
Same |
|
IN
|
Base Rate |
$4,399.13
|
Same |
|
KS
|
Base Rate |
$4,023.73
|
Same |
|
KY
|
Base Rate |
$4,881.34
|
Same |
|
LA
|
Base Rate |
$4,710.53
|
Same |
|
MA
|
Base Rate |
$4,236.56
|
Same |
|
MD
|
Base Rate |
$4,023.73
|
Same |
|
ME
|
Base Rate |
$4,236.56
|
Same |
|
MI
|
Base Rate |
$4,399.13
|
Same |
|
MN
|
Base Rate |
$4,399.13
|
Same |
|
MO
|
Base Rate |
$4,023.73
|
Same |
|
MS
|
Base Rate |
$4,881.34
|
Same |
|
MT
|
Base Rate |
$4,023.73
|
Same |
|
NC
|
Base Rate |
$4,881.34
|
Same |
|
ND
|
Base Rate |
$4,023.73
|
Same |
|
NE
|
Base Rate |
$4,023.73
|
Same |
|
NH
|
Base Rate |
$4,236.56
|
Same |
|
NJ
|
Base Rate |
$4,023.73
|
Same |
|
NM
|
Base Rate |
$4,710.53
|
Same |
|
NV
|
Base Rate |
$5,364.98
|
Same |
|
NY
|
Base Rate |
$4,023.73
|
Same |
|
OH
|
Base Rate |
$4,399.13
|
Same |
|
OK
|
Base Rate |
$4,710.53
|
Same |
|
OR
|
Base Rate |
$5,298.50
|
Same |
|
PA
|
Base Rate |
$4,023.73
|
Same |
|
PR
|
Base Rate |
$6,622.21
|
Same |
|
RI
|
Base Rate |
$4,236.56
|
Same |
|
SC
|
Base Rate |
$4,881.34
|
Same |
|
SD
|
Base Rate |
$4,023.73
|
Same |
|
TN
|
Base Rate |
$4,881.34
|
Same |
|
TX
|
Base Rate |
$4,710.53
|
Same |
|
UT
|
Base Rate |
$4,023.73
|
Same |
|
VA
|
Base Rate |
$4,023.73
|
Same |
|
VI
|
Base Rate |
$4,023.73
|
Same |
|
VT
|
Base Rate |
$4,236.56
|
Same |
|
WA
|
Base Rate |
$5,298.50
|
Same |
|
WI
|
Base Rate |
$4,399.13
|
Same |
|
WV
|
Base Rate |
$4,023.73
|
Same |
|
WY
|
Base Rate |
$4,023.73
|
Same |