L5341
Prosthetics & Orthotics
53 States
Hemipelvectomy, canadian type, molded socket, endoskeletal system, hip joint, single axis knee, sach foot
Short Desc
Hemipelvectomy canadian sach
Coverage determined by local carrier discretion.
Added Date
2002-01-01
Effective From
2002-01-01
National Floor
$6,187.30
National Ceiling
$8,249.73
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$11,984.41
|
Same |
|
AL
|
Base Rate |
$6,474.88
|
Same |
|
AR
|
Base Rate |
$7,400.44
|
Same |
|
AZ
|
Base Rate |
$8,249.73
|
Same |
|
CA
|
Base Rate |
$8,249.73
|
Same |
|
CO
|
Base Rate |
$7,426.46
|
Same |
|
CT
|
Base Rate |
$6,187.30
|
Same |
|
DC
|
Base Rate |
$6,187.30
|
Same |
|
DE
|
Base Rate |
$6,187.30
|
Same |
|
FL
|
Base Rate |
$6,474.88
|
Same |
|
GA
|
Base Rate |
$6,474.88
|
Same |
|
HI
|
Base Rate |
$12,930.77
|
Same |
|
IA
|
Base Rate |
$6,952.39
|
Same |
|
ID
|
Base Rate |
$7,846.67
|
Same |
|
IL
|
Base Rate |
$6,848.94
|
Same |
|
IN
|
Base Rate |
$6,848.94
|
Same |
|
KS
|
Base Rate |
$6,952.39
|
Same |
|
KY
|
Base Rate |
$6,474.88
|
Same |
|
LA
|
Base Rate |
$7,400.44
|
Same |
|
MA
|
Base Rate |
$6,187.30
|
Same |
|
MD
|
Base Rate |
$6,187.30
|
Same |
|
ME
|
Base Rate |
$6,187.30
|
Same |
|
MI
|
Base Rate |
$6,848.94
|
Same |
|
MN
|
Base Rate |
$6,848.94
|
Same |
|
MO
|
Base Rate |
$6,952.39
|
Same |
|
MS
|
Base Rate |
$6,474.88
|
Same |
|
MT
|
Base Rate |
$7,426.46
|
Same |
|
NC
|
Base Rate |
$6,474.88
|
Same |
|
ND
|
Base Rate |
$7,426.46
|
Same |
|
NE
|
Base Rate |
$6,952.39
|
Same |
|
NH
|
Base Rate |
$6,187.30
|
Same |
|
NJ
|
Base Rate |
$6,233.68
|
Same |
|
NM
|
Base Rate |
$7,400.44
|
Same |
|
NV
|
Base Rate |
$8,249.73
|
Same |
|
NY
|
Base Rate |
$6,233.68
|
Same |
|
OH
|
Base Rate |
$6,848.94
|
Same |
|
OK
|
Base Rate |
$7,400.44
|
Same |
|
OR
|
Base Rate |
$7,846.67
|
Same |
|
PA
|
Base Rate |
$6,187.30
|
Same |
|
PR
|
Base Rate |
$6,039.09
|
Same |
|
RI
|
Base Rate |
$6,187.30
|
Same |
|
SC
|
Base Rate |
$6,474.88
|
Same |
|
SD
|
Base Rate |
$7,426.46
|
Same |
|
TN
|
Base Rate |
$6,474.88
|
Same |
|
TX
|
Base Rate |
$7,400.44
|
Same |
|
UT
|
Base Rate |
$7,426.46
|
Same |
|
VA
|
Base Rate |
$6,187.30
|
Same |
|
VI
|
Base Rate |
$6,187.30
|
Same |
|
VT
|
Base Rate |
$6,187.30
|
Same |
|
WA
|
Base Rate |
$7,846.67
|
Same |
|
WI
|
Base Rate |
$6,848.94
|
Same |
|
WV
|
Base Rate |
$6,187.30
|
Same |
|
WY
|
Base Rate |
$7,426.46
|
Same |