L5658
Prosthetics & Orthotics
53 States
Addition to lower extremity, socket insert, above knee (kemblo, pelite, aliplast, plastazote or equal)
Short Desc
Socket insert above knee
Coverage determined by local carrier discretion.
Added Date
1986-01-01
Effective From
1986-01-01
National Floor
$445.13
National Ceiling
$593.51
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$442.23
|
Same |
|
AL
|
Base Rate |
$445.13
|
Same |
|
AR
|
Base Rate |
$445.13
|
Same |
|
AZ
|
Base Rate |
$460.83
|
Same |
|
CA
|
Base Rate |
$460.83
|
Same |
|
CO
|
Base Rate |
$510.21
|
Same |
|
CT
|
Base Rate |
$517.61
|
Same |
|
DC
|
Base Rate |
$471.60
|
Same |
|
DE
|
Base Rate |
$471.60
|
Same |
|
FL
|
Base Rate |
$445.13
|
Same |
|
GA
|
Base Rate |
$445.13
|
Same |
|
HI
|
Base Rate |
$472.86
|
Same |
|
IA
|
Base Rate |
$535.94
|
Same |
|
ID
|
Base Rate |
$593.51
|
Same |
|
IL
|
Base Rate |
$558.94
|
Same |
|
IN
|
Base Rate |
$558.94
|
Same |
|
KS
|
Base Rate |
$535.94
|
Same |
|
KY
|
Base Rate |
$445.13
|
Same |
|
LA
|
Base Rate |
$445.13
|
Same |
|
MA
|
Base Rate |
$517.61
|
Same |
|
MD
|
Base Rate |
$471.60
|
Same |
|
ME
|
Base Rate |
$517.61
|
Same |
|
MI
|
Base Rate |
$558.94
|
Same |
|
MN
|
Base Rate |
$558.94
|
Same |
|
MO
|
Base Rate |
$535.94
|
Same |
|
MS
|
Base Rate |
$445.13
|
Same |
|
MT
|
Base Rate |
$510.21
|
Same |
|
NC
|
Base Rate |
$445.13
|
Same |
|
ND
|
Base Rate |
$510.21
|
Same |
|
NE
|
Base Rate |
$535.94
|
Same |
|
NH
|
Base Rate |
$517.61
|
Same |
|
NJ
|
Base Rate |
$479.22
|
Same |
|
NM
|
Base Rate |
$445.13
|
Same |
|
NV
|
Base Rate |
$460.83
|
Same |
|
NY
|
Base Rate |
$479.22
|
Same |
|
OH
|
Base Rate |
$558.94
|
Same |
|
OK
|
Base Rate |
$445.13
|
Same |
|
OR
|
Base Rate |
$593.51
|
Same |
|
PA
|
Base Rate |
$471.60
|
Same |
|
PR
|
Base Rate |
$1,046.93
|
Same |
|
RI
|
Base Rate |
$517.61
|
Same |
|
SC
|
Base Rate |
$445.13
|
Same |
|
SD
|
Base Rate |
$510.21
|
Same |
|
TN
|
Base Rate |
$445.13
|
Same |
|
TX
|
Base Rate |
$445.13
|
Same |
|
UT
|
Base Rate |
$510.21
|
Same |
|
VA
|
Base Rate |
$471.60
|
Same |
|
VI
|
Base Rate |
$479.22
|
Same |
|
VT
|
Base Rate |
$517.61
|
Same |
|
WA
|
Base Rate |
$593.51
|
Same |
|
WI
|
Base Rate |
$558.94
|
Same |
|
WV
|
Base Rate |
$471.60
|
Same |
|
WY
|
Base Rate |
$510.21
|
Same |