L5643
Prosthetics & Orthotics
53 States
Addition to lower extremity, hip disarticulation, flexible inner socket, external frame
Short Desc
Hip flex inner socket ext fr
Coverage determined by local carrier discretion.
Added Date
1988-01-01
Effective From
1988-01-01
National Floor
$1,905.46
National Ceiling
$2,540.62
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,895.17
|
Same |
|
AL
|
Base Rate |
$1,905.46
|
Same |
|
AR
|
Base Rate |
$2,049.39
|
Same |
|
AZ
|
Base Rate |
$1,905.46
|
Same |
|
CA
|
Base Rate |
$1,905.46
|
Same |
|
CO
|
Base Rate |
$2,540.62
|
Same |
|
CT
|
Base Rate |
$2,540.62
|
Same |
|
DC
|
Base Rate |
$1,905.46
|
Same |
|
DE
|
Base Rate |
$1,905.46
|
Same |
|
FL
|
Base Rate |
$1,905.46
|
Same |
|
GA
|
Base Rate |
$1,905.46
|
Same |
|
HI
|
Base Rate |
$2,026.56
|
Same |
|
IA
|
Base Rate |
$1,905.46
|
Same |
|
ID
|
Base Rate |
$2,187.44
|
Same |
|
IL
|
Base Rate |
$2,466.73
|
Same |
|
IN
|
Base Rate |
$2,466.73
|
Same |
|
KS
|
Base Rate |
$1,905.46
|
Same |
|
KY
|
Base Rate |
$1,905.46
|
Same |
|
LA
|
Base Rate |
$2,049.39
|
Same |
|
MA
|
Base Rate |
$2,540.62
|
Same |
|
MD
|
Base Rate |
$1,905.46
|
Same |
|
ME
|
Base Rate |
$2,540.62
|
Same |
|
MI
|
Base Rate |
$2,466.73
|
Same |
|
MN
|
Base Rate |
$2,466.73
|
Same |
|
MO
|
Base Rate |
$1,905.46
|
Same |
|
MS
|
Base Rate |
$1,905.46
|
Same |
|
MT
|
Base Rate |
$2,540.62
|
Same |
|
NC
|
Base Rate |
$1,905.46
|
Same |
|
ND
|
Base Rate |
$2,540.62
|
Same |
|
NE
|
Base Rate |
$1,905.46
|
Same |
|
NH
|
Base Rate |
$2,540.62
|
Same |
|
NJ
|
Base Rate |
$1,905.46
|
Same |
|
NM
|
Base Rate |
$2,049.39
|
Same |
|
NV
|
Base Rate |
$1,905.46
|
Same |
|
NY
|
Base Rate |
$1,905.46
|
Same |
|
OH
|
Base Rate |
$2,466.73
|
Same |
|
OK
|
Base Rate |
$2,049.39
|
Same |
|
OR
|
Base Rate |
$2,187.44
|
Same |
|
PA
|
Base Rate |
$1,905.46
|
Same |
|
PR
|
Base Rate |
$1,380.05
|
Same |
|
RI
|
Base Rate |
$2,540.62
|
Same |
|
SC
|
Base Rate |
$1,905.46
|
Same |
|
SD
|
Base Rate |
$2,540.62
|
Same |
|
TN
|
Base Rate |
$1,905.46
|
Same |
|
TX
|
Base Rate |
$2,049.39
|
Same |
|
UT
|
Base Rate |
$2,540.62
|
Same |
|
VA
|
Base Rate |
$1,905.46
|
Same |
|
VI
|
Base Rate |
$1,905.46
|
Same |
|
VT
|
Base Rate |
$2,540.62
|
Same |
|
WA
|
Base Rate |
$2,187.44
|
Same |
|
WI
|
Base Rate |
$2,466.73
|
Same |
|
WV
|
Base Rate |
$1,905.46
|
Same |
|
WY
|
Base Rate |
$2,540.62
|
Same |