L5646
Prosthetics & Orthotics
53 States
Addition to lower extremity, below knee, air, fluid, gel or equal, cushion socket
Short Desc
Below knee cushion socket
Coverage determined by local carrier discretion.
Added Date
1986-01-01
Effective From
2004-01-01
National Floor
$670.77
National Ceiling
$894.36
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$541.12
|
Same |
|
AL
|
Base Rate |
$670.77
|
Same |
|
AR
|
Base Rate |
$870.73
|
Same |
|
AZ
|
Base Rate |
$670.77
|
Same |
|
CA
|
Base Rate |
$670.77
|
Same |
|
CO
|
Base Rate |
$868.83
|
Same |
|
CT
|
Base Rate |
$894.36
|
Same |
|
DC
|
Base Rate |
$670.77
|
Same |
|
DE
|
Base Rate |
$670.77
|
Same |
|
FL
|
Base Rate |
$670.77
|
Same |
|
GA
|
Base Rate |
$670.77
|
Same |
|
HI
|
Base Rate |
$578.62
|
Same |
|
IA
|
Base Rate |
$670.77
|
Same |
|
ID
|
Base Rate |
$718.04
|
Same |
|
IL
|
Base Rate |
$760.20
|
Same |
|
IN
|
Base Rate |
$760.20
|
Same |
|
KS
|
Base Rate |
$670.77
|
Same |
|
KY
|
Base Rate |
$670.77
|
Same |
|
LA
|
Base Rate |
$870.73
|
Same |
|
MA
|
Base Rate |
$894.36
|
Same |
|
MD
|
Base Rate |
$670.77
|
Same |
|
ME
|
Base Rate |
$894.36
|
Same |
|
MI
|
Base Rate |
$760.20
|
Same |
|
MN
|
Base Rate |
$760.20
|
Same |
|
MO
|
Base Rate |
$670.77
|
Same |
|
MS
|
Base Rate |
$670.77
|
Same |
|
MT
|
Base Rate |
$868.83
|
Same |
|
NC
|
Base Rate |
$670.77
|
Same |
|
ND
|
Base Rate |
$868.83
|
Same |
|
NE
|
Base Rate |
$670.77
|
Same |
|
NH
|
Base Rate |
$894.36
|
Same |
|
NJ
|
Base Rate |
$710.29
|
Same |
|
NM
|
Base Rate |
$870.73
|
Same |
|
NV
|
Base Rate |
$670.77
|
Same |
|
NY
|
Base Rate |
$710.29
|
Same |
|
OH
|
Base Rate |
$760.20
|
Same |
|
OK
|
Base Rate |
$870.73
|
Same |
|
OR
|
Base Rate |
$718.04
|
Same |
|
PA
|
Base Rate |
$670.77
|
Same |
|
PR
|
Base Rate |
$664.54
|
Same |
|
RI
|
Base Rate |
$894.36
|
Same |
|
SC
|
Base Rate |
$670.77
|
Same |
|
SD
|
Base Rate |
$868.83
|
Same |
|
TN
|
Base Rate |
$670.77
|
Same |
|
TX
|
Base Rate |
$870.73
|
Same |
|
UT
|
Base Rate |
$868.83
|
Same |
|
VA
|
Base Rate |
$670.77
|
Same |
|
VI
|
Base Rate |
$710.29
|
Same |
|
VT
|
Base Rate |
$894.36
|
Same |
|
WA
|
Base Rate |
$718.04
|
Same |
|
WI
|
Base Rate |
$760.20
|
Same |
|
WV
|
Base Rate |
$670.77
|
Same |
|
WY
|
Base Rate |
$868.83
|
Same |