L6638
Prosthetics & Orthotics
53 States
Upper extremity addition to prosthesis, electric locking feature, only for use with manually powered elbow
Short Desc
Elec lock on manual pw elbow
Coverage determined by local carrier discretion.
Added Date
2003-01-01
Effective From
2003-01-01
National Floor
$2,750.83
National Ceiling
$3,667.77
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$3,005.49
|
Same |
|
AL
|
Base Rate |
$3,095.98
|
Same |
|
AR
|
Base Rate |
$3,095.69
|
Same |
|
AZ
|
Base Rate |
$3,005.49
|
Same |
|
CA
|
Base Rate |
$3,005.49
|
Same |
|
CO
|
Base Rate |
$3,113.07
|
Same |
|
CT
|
Base Rate |
$3,005.49
|
Same |
|
DC
|
Base Rate |
$3,005.49
|
Same |
|
DE
|
Base Rate |
$3,005.49
|
Same |
|
FL
|
Base Rate |
$3,095.98
|
Same |
|
GA
|
Base Rate |
$3,095.98
|
Same |
|
HI
|
Base Rate |
$3,005.49
|
Same |
|
IA
|
Base Rate |
$3,064.21
|
Same |
|
ID
|
Base Rate |
$3,005.49
|
Same |
|
IL
|
Base Rate |
$3,079.31
|
Same |
|
IN
|
Base Rate |
$3,079.31
|
Same |
|
KS
|
Base Rate |
$3,064.21
|
Same |
|
KY
|
Base Rate |
$3,095.98
|
Same |
|
LA
|
Base Rate |
$3,095.69
|
Same |
|
MA
|
Base Rate |
$3,005.49
|
Same |
|
MD
|
Base Rate |
$3,005.49
|
Same |
|
ME
|
Base Rate |
$3,005.49
|
Same |
|
MI
|
Base Rate |
$3,079.31
|
Same |
|
MN
|
Base Rate |
$3,079.31
|
Same |
|
MO
|
Base Rate |
$3,064.21
|
Same |
|
MS
|
Base Rate |
$3,095.98
|
Same |
|
MT
|
Base Rate |
$3,113.07
|
Same |
|
NC
|
Base Rate |
$3,095.98
|
Same |
|
ND
|
Base Rate |
$3,113.07
|
Same |
|
NE
|
Base Rate |
$3,064.21
|
Same |
|
NH
|
Base Rate |
$3,005.49
|
Same |
|
NJ
|
Base Rate |
$3,005.49
|
Same |
|
NM
|
Base Rate |
$3,095.69
|
Same |
|
NV
|
Base Rate |
$3,005.49
|
Same |
|
NY
|
Base Rate |
$3,005.49
|
Same |
|
OH
|
Base Rate |
$3,079.31
|
Same |
|
OK
|
Base Rate |
$3,095.69
|
Same |
|
OR
|
Base Rate |
$3,005.49
|
Same |
|
PA
|
Base Rate |
$3,005.49
|
Same |
|
PR
|
Base Rate |
$3,306.01
|
Same |
|
RI
|
Base Rate |
$3,005.49
|
Same |
|
SC
|
Base Rate |
$3,095.98
|
Same |
|
SD
|
Base Rate |
$3,113.07
|
Same |
|
TN
|
Base Rate |
$3,095.98
|
Same |
|
TX
|
Base Rate |
$3,095.69
|
Same |
|
UT
|
Base Rate |
$3,113.07
|
Same |
|
VA
|
Base Rate |
$3,005.49
|
Same |
|
VI
|
Base Rate |
$3,306.01
|
Same |
|
VT
|
Base Rate |
$3,005.49
|
Same |
|
WA
|
Base Rate |
$3,005.49
|
Same |
|
WI
|
Base Rate |
$3,079.31
|
Same |
|
WV
|
Base Rate |
$3,005.49
|
Same |
|
WY
|
Base Rate |
$3,113.07
|
Same |