L6696
Prosthetics & Orthotics
53 States
Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)
Short Desc
Cus elbo skt in for con/atyp
Coverage determined by local carrier discretion.
Added Date
2005-01-01
Effective From
2005-01-01
National Floor
$1,447.31
National Ceiling
$1,929.74
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$1,580.90
|
Same |
|
AL
|
Base Rate |
$1,628.51
|
Same |
|
AR
|
Base Rate |
$1,628.34
|
Same |
|
AZ
|
Base Rate |
$1,580.90
|
Same |
|
CA
|
Base Rate |
$1,580.90
|
Same |
|
CO
|
Base Rate |
$1,640.77
|
Same |
|
CT
|
Base Rate |
$1,580.90
|
Same |
|
DC
|
Base Rate |
$1,580.90
|
Same |
|
DE
|
Base Rate |
$1,580.90
|
Same |
|
FL
|
Base Rate |
$1,628.51
|
Same |
|
GA
|
Base Rate |
$1,628.51
|
Same |
|
HI
|
Base Rate |
$1,580.90
|
Same |
|
IA
|
Base Rate |
$1,611.74
|
Same |
|
ID
|
Base Rate |
$1,580.90
|
Same |
|
IL
|
Base Rate |
$1,619.74
|
Same |
|
IN
|
Base Rate |
$1,619.74
|
Same |
|
KS
|
Base Rate |
$1,611.74
|
Same |
|
KY
|
Base Rate |
$1,628.51
|
Same |
|
LA
|
Base Rate |
$1,628.34
|
Same |
|
MA
|
Base Rate |
$1,580.90
|
Same |
|
MD
|
Base Rate |
$1,580.90
|
Same |
|
ME
|
Base Rate |
$1,580.90
|
Same |
|
MI
|
Base Rate |
$1,619.74
|
Same |
|
MN
|
Base Rate |
$1,619.74
|
Same |
|
MO
|
Base Rate |
$1,611.74
|
Same |
|
MS
|
Base Rate |
$1,628.51
|
Same |
|
MT
|
Base Rate |
$1,640.77
|
Same |
|
NC
|
Base Rate |
$1,628.51
|
Same |
|
ND
|
Base Rate |
$1,640.77
|
Same |
|
NE
|
Base Rate |
$1,611.74
|
Same |
|
NH
|
Base Rate |
$1,580.90
|
Same |
|
NJ
|
Base Rate |
$1,580.90
|
Same |
|
NM
|
Base Rate |
$1,628.34
|
Same |
|
NV
|
Base Rate |
$1,580.90
|
Same |
|
NY
|
Base Rate |
$1,580.90
|
Same |
|
OH
|
Base Rate |
$1,619.74
|
Same |
|
OK
|
Base Rate |
$1,628.34
|
Same |
|
OR
|
Base Rate |
$1,580.90
|
Same |
|
PA
|
Base Rate |
$1,580.90
|
Same |
|
PR
|
Base Rate |
$1,738.98
|
Same |
|
RI
|
Base Rate |
$1,580.90
|
Same |
|
SC
|
Base Rate |
$1,628.51
|
Same |
|
SD
|
Base Rate |
$1,640.77
|
Same |
|
TN
|
Base Rate |
$1,628.51
|
Same |
|
TX
|
Base Rate |
$1,628.34
|
Same |
|
UT
|
Base Rate |
$1,640.77
|
Same |
|
VA
|
Base Rate |
$1,580.90
|
Same |
|
VI
|
Base Rate |
$1,738.98
|
Same |
|
VT
|
Base Rate |
$1,580.90
|
Same |
|
WA
|
Base Rate |
$1,580.90
|
Same |
|
WI
|
Base Rate |
$1,619.74
|
Same |
|
WV
|
Base Rate |
$1,580.90
|
Same |
|
WY
|
Base Rate |
$1,640.77
|
Same |