L5781
Prosthetics & Orthotics
53 States
Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system
Short Desc
Lower limb pros vacuum pump
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2003-01-01
National Floor
$4,401.32
National Ceiling
$5,868.42
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$4,808.77
|
Same |
|
AL
|
Base Rate |
$4,953.58
|
Same |
|
AR
|
Base Rate |
$4,953.14
|
Same |
|
AZ
|
Base Rate |
$4,808.77
|
Same |
|
CA
|
Base Rate |
$4,808.77
|
Same |
|
CO
|
Base Rate |
$4,980.92
|
Same |
|
CT
|
Base Rate |
$4,808.77
|
Same |
|
DC
|
Base Rate |
$4,808.77
|
Same |
|
DE
|
Base Rate |
$4,808.77
|
Same |
|
FL
|
Base Rate |
$4,953.58
|
Same |
|
GA
|
Base Rate |
$4,953.58
|
Same |
|
HI
|
Base Rate |
$4,808.77
|
Same |
|
IA
|
Base Rate |
$4,902.67
|
Same |
|
ID
|
Base Rate |
$4,808.77
|
Same |
|
IL
|
Base Rate |
$4,926.90
|
Same |
|
IN
|
Base Rate |
$4,926.90
|
Same |
|
KS
|
Base Rate |
$4,902.67
|
Same |
|
KY
|
Base Rate |
$4,953.58
|
Same |
|
LA
|
Base Rate |
$4,953.14
|
Same |
|
MA
|
Base Rate |
$4,808.77
|
Same |
|
MD
|
Base Rate |
$4,808.77
|
Same |
|
ME
|
Base Rate |
$4,808.77
|
Same |
|
MI
|
Base Rate |
$4,926.90
|
Same |
|
MN
|
Base Rate |
$4,926.90
|
Same |
|
MO
|
Base Rate |
$4,902.67
|
Same |
|
MS
|
Base Rate |
$4,953.58
|
Same |
|
MT
|
Base Rate |
$4,980.92
|
Same |
|
NC
|
Base Rate |
$4,953.58
|
Same |
|
ND
|
Base Rate |
$4,980.92
|
Same |
|
NE
|
Base Rate |
$4,902.67
|
Same |
|
NH
|
Base Rate |
$4,808.77
|
Same |
|
NJ
|
Base Rate |
$4,808.77
|
Same |
|
NM
|
Base Rate |
$4,953.14
|
Same |
|
NV
|
Base Rate |
$4,808.77
|
Same |
|
NY
|
Base Rate |
$4,808.77
|
Same |
|
OH
|
Base Rate |
$4,926.90
|
Same |
|
OK
|
Base Rate |
$4,953.14
|
Same |
|
OR
|
Base Rate |
$4,808.77
|
Same |
|
PA
|
Base Rate |
$4,808.77
|
Same |
|
PR
|
Base Rate |
$5,289.62
|
Same |
|
RI
|
Base Rate |
$4,808.77
|
Same |
|
SC
|
Base Rate |
$4,953.58
|
Same |
|
SD
|
Base Rate |
$4,980.92
|
Same |
|
TN
|
Base Rate |
$4,953.58
|
Same |
|
TX
|
Base Rate |
$4,953.14
|
Same |
|
UT
|
Base Rate |
$4,980.92
|
Same |
|
VA
|
Base Rate |
$4,808.77
|
Same |
|
VI
|
Base Rate |
$5,289.62
|
Same |
|
VT
|
Base Rate |
$4,808.77
|
Same |
|
WA
|
Base Rate |
$4,808.77
|
Same |
|
WI
|
Base Rate |
$4,926.90
|
Same |
|
WV
|
Base Rate |
$4,808.77
|
Same |
|
WY
|
Base Rate |
$4,980.92
|
Same |