L5858
Prosthetics & Orthotics
53 States
Addition to lower extremity prosthesis, endoskeletal knee shin system, microprocessor control feature, stance phase only, includes electronic sensor(s), any type
Short Desc
Stance phase only
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2006-01-01
National Floor
$20,443.83
National Ceiling
$27,258.44
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$22,336.47
|
Same |
|
AL
|
Base Rate |
$23,009.05
|
Same |
|
AR
|
Base Rate |
$23,006.91
|
Same |
|
AZ
|
Base Rate |
$22,336.47
|
Same |
|
CA
|
Base Rate |
$22,336.47
|
Same |
|
CO
|
Base Rate |
$23,135.94
|
Same |
|
CT
|
Base Rate |
$22,336.47
|
Same |
|
DC
|
Base Rate |
$22,336.47
|
Same |
|
DE
|
Base Rate |
$22,336.47
|
Same |
|
FL
|
Base Rate |
$23,009.05
|
Same |
|
GA
|
Base Rate |
$23,009.05
|
Same |
|
HI
|
Base Rate |
$22,336.47
|
Same |
|
IA
|
Base Rate |
$22,772.63
|
Same |
|
ID
|
Base Rate |
$22,336.47
|
Same |
|
IL
|
Base Rate |
$22,885.05
|
Same |
|
IN
|
Base Rate |
$22,885.05
|
Same |
|
KS
|
Base Rate |
$22,772.63
|
Same |
|
KY
|
Base Rate |
$23,009.05
|
Same |
|
LA
|
Base Rate |
$23,006.91
|
Same |
|
MA
|
Base Rate |
$22,336.47
|
Same |
|
MD
|
Base Rate |
$22,336.47
|
Same |
|
ME
|
Base Rate |
$22,336.47
|
Same |
|
MI
|
Base Rate |
$22,885.05
|
Same |
|
MN
|
Base Rate |
$22,885.05
|
Same |
|
MO
|
Base Rate |
$22,772.63
|
Same |
|
MS
|
Base Rate |
$23,009.05
|
Same |
|
MT
|
Base Rate |
$23,135.94
|
Same |
|
NC
|
Base Rate |
$23,009.05
|
Same |
|
ND
|
Base Rate |
$23,135.94
|
Same |
|
NE
|
Base Rate |
$22,772.63
|
Same |
|
NH
|
Base Rate |
$22,336.47
|
Same |
|
NJ
|
Base Rate |
$22,336.47
|
Same |
|
NM
|
Base Rate |
$23,006.91
|
Same |
|
NV
|
Base Rate |
$22,336.47
|
Same |
|
NY
|
Base Rate |
$22,336.47
|
Same |
|
OH
|
Base Rate |
$22,885.05
|
Same |
|
OK
|
Base Rate |
$23,006.91
|
Same |
|
OR
|
Base Rate |
$22,336.47
|
Same |
|
PA
|
Base Rate |
$22,336.47
|
Same |
|
PR
|
Base Rate |
$24,570.15
|
Same |
|
RI
|
Base Rate |
$22,336.47
|
Same |
|
SC
|
Base Rate |
$23,009.05
|
Same |
|
SD
|
Base Rate |
$23,135.94
|
Same |
|
TN
|
Base Rate |
$23,009.05
|
Same |
|
TX
|
Base Rate |
$23,006.91
|
Same |
|
UT
|
Base Rate |
$23,135.94
|
Same |
|
VA
|
Base Rate |
$22,336.47
|
Same |
|
VI
|
Base Rate |
$24,570.15
|
Same |
|
VT
|
Base Rate |
$22,336.47
|
Same |
|
WA
|
Base Rate |
$22,336.47
|
Same |
|
WI
|
Base Rate |
$22,885.05
|
Same |
|
WV
|
Base Rate |
$22,336.47
|
Same |
|
WY
|
Base Rate |
$23,135.94
|
Same |