L5673
Prosthetics & Orthotics
53 States
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism
Short Desc
Socket insert w lock mech
Coverage determined by local carrier discretion.
Added Date
2004-01-01
Effective From
2025-10-01
National Floor
$818.06
National Ceiling
$1,090.75
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,025.06
|
Same |
|
AL
|
Base Rate |
$870.51
|
Same |
|
AR
|
Base Rate |
$896.90
|
Same |
|
AZ
|
Base Rate |
$959.29
|
Same |
|
CA
|
Base Rate |
$959.29
|
Same |
|
CO
|
Base Rate |
$927.59
|
Same |
|
CT
|
Base Rate |
$965.82
|
Same |
|
DC
|
Base Rate |
$860.10
|
Same |
|
DE
|
Base Rate |
$860.10
|
Same |
|
FL
|
Base Rate |
$870.51
|
Same |
|
GA
|
Base Rate |
$870.51
|
Same |
|
HI
|
Base Rate |
$1,196.65
|
Same |
|
IA
|
Base Rate |
$917.08
|
Same |
|
ID
|
Base Rate |
$876.96
|
Same |
|
IL
|
Base Rate |
$967.82
|
Same |
|
IN
|
Base Rate |
$967.82
|
Same |
|
KS
|
Base Rate |
$917.08
|
Same |
|
KY
|
Base Rate |
$870.51
|
Same |
|
LA
|
Base Rate |
$896.90
|
Same |
|
MA
|
Base Rate |
$965.82
|
Same |
|
MD
|
Base Rate |
$860.10
|
Same |
|
ME
|
Base Rate |
$965.82
|
Same |
|
MI
|
Base Rate |
$967.82
|
Same |
|
MN
|
Base Rate |
$967.82
|
Same |
|
MO
|
Base Rate |
$917.08
|
Same |
|
MS
|
Base Rate |
$870.51
|
Same |
|
MT
|
Base Rate |
$927.59
|
Same |
|
NC
|
Base Rate |
$870.51
|
Same |
|
ND
|
Base Rate |
$927.59
|
Same |
|
NE
|
Base Rate |
$917.08
|
Same |
|
NH
|
Base Rate |
$965.82
|
Same |
|
NJ
|
Base Rate |
$818.06
|
Same |
|
NM
|
Base Rate |
$896.90
|
Same |
|
NV
|
Base Rate |
$959.29
|
Same |
|
NY
|
Base Rate |
$818.06
|
Same |
|
OH
|
Base Rate |
$967.82
|
Same |
|
OK
|
Base Rate |
$896.90
|
Same |
|
OR
|
Base Rate |
$876.96
|
Same |
|
PA
|
Base Rate |
$860.10
|
Same |
|
PR
|
Base Rate |
$759.94
|
Same |
|
RI
|
Base Rate |
$965.82
|
Same |
|
SC
|
Base Rate |
$870.51
|
Same |
|
SD
|
Base Rate |
$927.59
|
Same |
|
TN
|
Base Rate |
$870.51
|
Same |
|
TX
|
Base Rate |
$896.90
|
Same |
|
UT
|
Base Rate |
$927.59
|
Same |
|
VA
|
Base Rate |
$860.10
|
Same |
|
VI
|
Base Rate |
$820.22
|
Same |
|
VT
|
Base Rate |
$965.82
|
Same |
|
WA
|
Base Rate |
$876.96
|
Same |
|
WI
|
Base Rate |
$967.82
|
Same |
|
WV
|
Base Rate |
$860.10
|
Same |
|
WY
|
Base Rate |
$927.59
|
Same |