L6975
Prosthetics & Orthotics
53 States
Interscapular-thoracic, external power, molded inner socket, removable shoulder shell, shoulder bulkhead, humeral section, mechanical elbow, forearm, otto bock or equal electrodes, cables, two batteries and one charger, myoelectronic control of terminal device
Short Desc
Interscap-thor myoelectronic
Coverage determined by local carrier discretion.
Added Date
1988-01-01
Effective From
1996-01-01
National Floor
$19,564.01
National Ceiling
$26,085.35
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$22,805.81
|
Same |
|
AL
|
Base Rate |
$20,131.45
|
Same |
|
AR
|
Base Rate |
$23,640.73
|
Same |
|
AZ
|
Base Rate |
$22,747.26
|
Same |
|
CA
|
Base Rate |
$22,747.26
|
Same |
|
CO
|
Base Rate |
$23,106.59
|
Same |
|
CT
|
Base Rate |
$23,078.64
|
Same |
|
DC
|
Base Rate |
$21,646.96
|
Same |
|
DE
|
Base Rate |
$21,646.96
|
Same |
|
FL
|
Base Rate |
$20,131.45
|
Same |
|
GA
|
Base Rate |
$20,131.45
|
Same |
|
HI
|
Base Rate |
$24,386.40
|
Same |
|
IA
|
Base Rate |
$20,838.07
|
Same |
|
ID
|
Base Rate |
$19,564.01
|
Same |
|
IL
|
Base Rate |
$21,834.21
|
Same |
|
IN
|
Base Rate |
$21,834.21
|
Same |
|
KS
|
Base Rate |
$20,838.07
|
Same |
|
KY
|
Base Rate |
$20,131.45
|
Same |
|
LA
|
Base Rate |
$23,640.73
|
Same |
|
MA
|
Base Rate |
$23,078.64
|
Same |
|
MD
|
Base Rate |
$21,646.96
|
Same |
|
ME
|
Base Rate |
$23,078.64
|
Same |
|
MI
|
Base Rate |
$21,834.21
|
Same |
|
MN
|
Base Rate |
$21,834.21
|
Same |
|
MO
|
Base Rate |
$20,838.07
|
Same |
|
MS
|
Base Rate |
$20,131.45
|
Same |
|
MT
|
Base Rate |
$23,106.59
|
Same |
|
NC
|
Base Rate |
$20,131.45
|
Same |
|
ND
|
Base Rate |
$23,106.59
|
Same |
|
NE
|
Base Rate |
$20,838.07
|
Same |
|
NH
|
Base Rate |
$23,078.64
|
Same |
|
NJ
|
Base Rate |
$19,564.01
|
Same |
|
NM
|
Base Rate |
$23,640.73
|
Same |
|
NV
|
Base Rate |
$22,747.26
|
Same |
|
NY
|
Base Rate |
$19,564.01
|
Same |
|
OH
|
Base Rate |
$21,834.21
|
Same |
|
OK
|
Base Rate |
$23,640.73
|
Same |
|
OR
|
Base Rate |
$19,564.01
|
Same |
|
PA
|
Base Rate |
$21,646.96
|
Same |
|
PR
|
Base Rate |
$18,180.91
|
Same |
|
RI
|
Base Rate |
$23,078.64
|
Same |
|
SC
|
Base Rate |
$20,131.45
|
Same |
|
SD
|
Base Rate |
$23,106.59
|
Same |
|
TN
|
Base Rate |
$20,131.45
|
Same |
|
TX
|
Base Rate |
$23,640.73
|
Same |
|
UT
|
Base Rate |
$23,106.59
|
Same |
|
VA
|
Base Rate |
$21,646.96
|
Same |
|
VI
|
Base Rate |
$19,564.01
|
Same |
|
VT
|
Base Rate |
$23,078.64
|
Same |
|
WA
|
Base Rate |
$19,564.01
|
Same |
|
WI
|
Base Rate |
$21,834.21
|
Same |
|
WV
|
Base Rate |
$21,646.96
|
Same |
|
WY
|
Base Rate |
$23,106.59
|
Same |