L6677
Prosthetics & Orthotics
53 States
Upper extremity addition, harness, triple control, simultaneous operation of terminal device and elbow
Short Desc
Ue triple control harness
Coverage determined by local carrier discretion.
Added Date
2006-01-01
Effective From
2006-01-01
National Floor
$326.32
National Ceiling
$435.09
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$356.52
|
Same |
|
AL
|
Base Rate |
$367.30
|
Same |
|
AR
|
Base Rate |
$367.25
|
Same |
|
AZ
|
Base Rate |
$356.52
|
Same |
|
CA
|
Base Rate |
$356.52
|
Same |
|
CO
|
Base Rate |
$369.29
|
Same |
|
CT
|
Base Rate |
$356.52
|
Same |
|
DC
|
Base Rate |
$356.52
|
Same |
|
DE
|
Base Rate |
$356.52
|
Same |
|
FL
|
Base Rate |
$367.30
|
Same |
|
GA
|
Base Rate |
$367.30
|
Same |
|
HI
|
Base Rate |
$356.52
|
Same |
|
IA
|
Base Rate |
$363.43
|
Same |
|
ID
|
Base Rate |
$356.52
|
Same |
|
IL
|
Base Rate |
$365.26
|
Same |
|
IN
|
Base Rate |
$365.26
|
Same |
|
KS
|
Base Rate |
$363.43
|
Same |
|
KY
|
Base Rate |
$367.30
|
Same |
|
LA
|
Base Rate |
$367.25
|
Same |
|
MA
|
Base Rate |
$356.52
|
Same |
|
MD
|
Base Rate |
$356.52
|
Same |
|
ME
|
Base Rate |
$356.52
|
Same |
|
MI
|
Base Rate |
$365.26
|
Same |
|
MN
|
Base Rate |
$365.26
|
Same |
|
MO
|
Base Rate |
$363.43
|
Same |
|
MS
|
Base Rate |
$367.30
|
Same |
|
MT
|
Base Rate |
$369.29
|
Same |
|
NC
|
Base Rate |
$367.30
|
Same |
|
ND
|
Base Rate |
$369.29
|
Same |
|
NE
|
Base Rate |
$363.43
|
Same |
|
NH
|
Base Rate |
$356.52
|
Same |
|
NJ
|
Base Rate |
$356.52
|
Same |
|
NM
|
Base Rate |
$367.25
|
Same |
|
NV
|
Base Rate |
$356.52
|
Same |
|
NY
|
Base Rate |
$356.52
|
Same |
|
OH
|
Base Rate |
$365.26
|
Same |
|
OK
|
Base Rate |
$367.25
|
Same |
|
OR
|
Base Rate |
$356.52
|
Same |
|
PA
|
Base Rate |
$356.52
|
Same |
|
PR
|
Base Rate |
$392.16
|
Same |
|
RI
|
Base Rate |
$356.52
|
Same |
|
SC
|
Base Rate |
$367.30
|
Same |
|
SD
|
Base Rate |
$369.29
|
Same |
|
TN
|
Base Rate |
$367.30
|
Same |
|
TX
|
Base Rate |
$367.25
|
Same |
|
UT
|
Base Rate |
$369.29
|
Same |
|
VA
|
Base Rate |
$356.52
|
Same |
|
VI
|
Base Rate |
$392.16
|
Same |
|
VT
|
Base Rate |
$356.52
|
Same |
|
WA
|
Base Rate |
$356.52
|
Same |
|
WI
|
Base Rate |
$365.26
|
Same |
|
WV
|
Base Rate |
$356.52
|
Same |
|
WY
|
Base Rate |
$369.29
|
Same |