L5690
Prosthetics & Orthotics
53 States
Addition to lower extremity, below knee, waist belt, padded and lined
Short Desc
Bk waist belt padded and lin
Coverage determined by local carrier discretion.
Added Date
1986-01-01
Effective From
1986-01-01
National Floor
$119.80
National Ceiling
$159.73
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$163.33
|
Same |
|
AL
|
Base Rate |
$119.80
|
Same |
|
AR
|
Base Rate |
$132.07
|
Same |
|
AZ
|
Base Rate |
$159.73
|
Same |
|
CA
|
Base Rate |
$159.73
|
Same |
|
CO
|
Base Rate |
$119.80
|
Same |
|
CT
|
Base Rate |
$159.73
|
Same |
|
DC
|
Base Rate |
$144.80
|
Same |
|
DE
|
Base Rate |
$144.80
|
Same |
|
FL
|
Base Rate |
$119.80
|
Same |
|
GA
|
Base Rate |
$119.80
|
Same |
|
HI
|
Base Rate |
$174.68
|
Same |
|
IA
|
Base Rate |
$122.10
|
Same |
|
ID
|
Base Rate |
$129.94
|
Same |
|
IL
|
Base Rate |
$153.65
|
Same |
|
IN
|
Base Rate |
$153.65
|
Same |
|
KS
|
Base Rate |
$122.10
|
Same |
|
KY
|
Base Rate |
$119.80
|
Same |
|
LA
|
Base Rate |
$132.07
|
Same |
|
MA
|
Base Rate |
$159.73
|
Same |
|
MD
|
Base Rate |
$144.80
|
Same |
|
ME
|
Base Rate |
$159.73
|
Same |
|
MI
|
Base Rate |
$153.65
|
Same |
|
MN
|
Base Rate |
$153.65
|
Same |
|
MO
|
Base Rate |
$122.10
|
Same |
|
MS
|
Base Rate |
$119.80
|
Same |
|
MT
|
Base Rate |
$119.80
|
Same |
|
NC
|
Base Rate |
$119.80
|
Same |
|
ND
|
Base Rate |
$119.80
|
Same |
|
NE
|
Base Rate |
$122.10
|
Same |
|
NH
|
Base Rate |
$159.73
|
Same |
|
NJ
|
Base Rate |
$126.76
|
Same |
|
NM
|
Base Rate |
$132.07
|
Same |
|
NV
|
Base Rate |
$159.73
|
Same |
|
NY
|
Base Rate |
$126.76
|
Same |
|
OH
|
Base Rate |
$153.65
|
Same |
|
OK
|
Base Rate |
$132.07
|
Same |
|
OR
|
Base Rate |
$129.94
|
Same |
|
PA
|
Base Rate |
$144.80
|
Same |
|
PR
|
Base Rate |
$114.21
|
Same |
|
RI
|
Base Rate |
$159.73
|
Same |
|
SC
|
Base Rate |
$119.80
|
Same |
|
SD
|
Base Rate |
$119.80
|
Same |
|
TN
|
Base Rate |
$119.80
|
Same |
|
TX
|
Base Rate |
$132.07
|
Same |
|
UT
|
Base Rate |
$119.80
|
Same |
|
VA
|
Base Rate |
$144.80
|
Same |
|
VI
|
Base Rate |
$126.76
|
Same |
|
VT
|
Base Rate |
$159.73
|
Same |
|
WA
|
Base Rate |
$129.94
|
Same |
|
WI
|
Base Rate |
$153.65
|
Same |
|
WV
|
Base Rate |
$144.80
|
Same |
|
WY
|
Base Rate |
$119.80
|
Same |