L5683
Prosthetics & Orthotics
53 States
Addition to lower extremity, below knee/above knee, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
Short Desc
Initial custom socket insert
Coverage determined by local carrier discretion.
Added Date
2004-01-01
Effective From
2004-01-01
National Floor
$1,447.31
National Ceiling
$1,929.74
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,580.90
|
Same |
|
AL
|
Base Rate |
$1,628.51
|
Same |
|
AR
|
Base Rate |
$1,628.34
|
Same |
|
AZ
|
Base Rate |
$1,580.90
|
Same |
|
CA
|
Base Rate |
$1,580.90
|
Same |
|
CO
|
Base Rate |
$1,640.77
|
Same |
|
CT
|
Base Rate |
$1,580.90
|
Same |
|
DC
|
Base Rate |
$1,580.90
|
Same |
|
DE
|
Base Rate |
$1,580.90
|
Same |
|
FL
|
Base Rate |
$1,628.51
|
Same |
|
GA
|
Base Rate |
$1,628.51
|
Same |
|
HI
|
Base Rate |
$1,580.90
|
Same |
|
IA
|
Base Rate |
$1,611.74
|
Same |
|
ID
|
Base Rate |
$1,580.90
|
Same |
|
IL
|
Base Rate |
$1,619.74
|
Same |
|
IN
|
Base Rate |
$1,619.74
|
Same |
|
KS
|
Base Rate |
$1,611.74
|
Same |
|
KY
|
Base Rate |
$1,628.51
|
Same |
|
LA
|
Base Rate |
$1,628.34
|
Same |
|
MA
|
Base Rate |
$1,580.90
|
Same |
|
MD
|
Base Rate |
$1,580.90
|
Same |
|
ME
|
Base Rate |
$1,580.90
|
Same |
|
MI
|
Base Rate |
$1,619.74
|
Same |
|
MN
|
Base Rate |
$1,619.74
|
Same |
|
MO
|
Base Rate |
$1,611.74
|
Same |
|
MS
|
Base Rate |
$1,628.51
|
Same |
|
MT
|
Base Rate |
$1,640.77
|
Same |
|
NC
|
Base Rate |
$1,628.51
|
Same |
|
ND
|
Base Rate |
$1,640.77
|
Same |
|
NE
|
Base Rate |
$1,611.74
|
Same |
|
NH
|
Base Rate |
$1,580.90
|
Same |
|
NJ
|
Base Rate |
$1,580.90
|
Same |
|
NM
|
Base Rate |
$1,628.34
|
Same |
|
NV
|
Base Rate |
$1,580.90
|
Same |
|
NY
|
Base Rate |
$1,580.90
|
Same |
|
OH
|
Base Rate |
$1,619.74
|
Same |
|
OK
|
Base Rate |
$1,628.34
|
Same |
|
OR
|
Base Rate |
$1,580.90
|
Same |
|
PA
|
Base Rate |
$1,580.90
|
Same |
|
PR
|
Base Rate |
$1,738.98
|
Same |
|
RI
|
Base Rate |
$1,580.90
|
Same |
|
SC
|
Base Rate |
$1,628.51
|
Same |
|
SD
|
Base Rate |
$1,640.77
|
Same |
|
TN
|
Base Rate |
$1,628.51
|
Same |
|
TX
|
Base Rate |
$1,628.34
|
Same |
|
UT
|
Base Rate |
$1,640.77
|
Same |
|
VA
|
Base Rate |
$1,580.90
|
Same |
|
VI
|
Base Rate |
$1,738.98
|
Same |
|
VT
|
Base Rate |
$1,580.90
|
Same |
|
WA
|
Base Rate |
$1,580.90
|
Same |
|
WI
|
Base Rate |
$1,619.74
|
Same |
|
WV
|
Base Rate |
$1,580.90
|
Same |
|
WY
|
Base Rate |
$1,640.77
|
Same |