L6584
Prosthetics & Orthotics
53 States
Preparatory, elbow disarticulation or above elbow, single wall plastic socket, friction wrist, locking elbow, figure of eight harness, fair lead cable control, usmc or equal pylon, no cover, molded to patient model
Short Desc
Elbow fair lead cable molded
Coverage determined by local carrier discretion.
Added Date
1988-01-01
Effective From
1996-01-01
National Floor
$2,505.80
National Ceiling
$3,341.07
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$2,779.49
|
Same |
|
AL
|
Base Rate |
$2,905.79
|
Same |
|
AR
|
Base Rate |
$2,725.54
|
Same |
|
AZ
|
Base Rate |
$2,735.49
|
Same |
|
CA
|
Base Rate |
$2,735.49
|
Same |
|
CO
|
Base Rate |
$2,505.80
|
Same |
|
CT
|
Base Rate |
$2,906.35
|
Same |
|
DC
|
Base Rate |
$2,729.32
|
Same |
|
DE
|
Base Rate |
$2,729.32
|
Same |
|
FL
|
Base Rate |
$2,905.79
|
Same |
|
GA
|
Base Rate |
$2,905.79
|
Same |
|
HI
|
Base Rate |
$2,972.12
|
Same |
|
IA
|
Base Rate |
$2,540.76
|
Same |
|
ID
|
Base Rate |
$2,977.56
|
Same |
|
IL
|
Base Rate |
$3,091.67
|
Same |
|
IN
|
Base Rate |
$3,091.67
|
Same |
|
KS
|
Base Rate |
$2,540.76
|
Same |
|
KY
|
Base Rate |
$2,905.79
|
Same |
|
LA
|
Base Rate |
$2,725.54
|
Same |
|
MA
|
Base Rate |
$2,906.35
|
Same |
|
MD
|
Base Rate |
$2,729.32
|
Same |
|
ME
|
Base Rate |
$2,906.35
|
Same |
|
MI
|
Base Rate |
$3,091.67
|
Same |
|
MN
|
Base Rate |
$3,091.67
|
Same |
|
MO
|
Base Rate |
$2,540.76
|
Same |
|
MS
|
Base Rate |
$2,905.79
|
Same |
|
MT
|
Base Rate |
$2,505.80
|
Same |
|
NC
|
Base Rate |
$2,905.79
|
Same |
|
ND
|
Base Rate |
$2,505.80
|
Same |
|
NE
|
Base Rate |
$2,540.76
|
Same |
|
NH
|
Base Rate |
$2,906.35
|
Same |
|
NJ
|
Base Rate |
$2,572.74
|
Same |
|
NM
|
Base Rate |
$2,725.54
|
Same |
|
NV
|
Base Rate |
$2,735.49
|
Same |
|
NY
|
Base Rate |
$2,572.74
|
Same |
|
OH
|
Base Rate |
$3,091.67
|
Same |
|
OK
|
Base Rate |
$2,725.54
|
Same |
|
OR
|
Base Rate |
$2,977.56
|
Same |
|
PA
|
Base Rate |
$2,729.32
|
Same |
|
PR
|
Base Rate |
$3,426.39
|
Same |
|
RI
|
Base Rate |
$2,906.35
|
Same |
|
SC
|
Base Rate |
$2,905.79
|
Same |
|
SD
|
Base Rate |
$2,505.80
|
Same |
|
TN
|
Base Rate |
$2,905.79
|
Same |
|
TX
|
Base Rate |
$2,725.54
|
Same |
|
UT
|
Base Rate |
$2,505.80
|
Same |
|
VA
|
Base Rate |
$2,729.32
|
Same |
|
VI
|
Base Rate |
$2,572.74
|
Same |
|
VT
|
Base Rate |
$2,906.35
|
Same |
|
WA
|
Base Rate |
$2,977.56
|
Same |
|
WI
|
Base Rate |
$3,091.67
|
Same |
|
WV
|
Base Rate |
$2,729.32
|
Same |
|
WY
|
Base Rate |
$2,505.80
|
Same |