L7406
Prosthetics & Orthotics
53 States
Addition to upper extremity prosthesis, user adjustable, mechanical, residual limb volume management system (with or without lamination kit)
Short Desc
Add upp ext mec limb vol lam
Coverage determined by local carrier discretion.
Added Date
2025-04-01
Effective From
2025-10-01
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$3,150.07
|
Same |
|
AL
|
Base Rate |
$3,150.07
|
Same |
|
AR
|
Base Rate |
$3,150.07
|
Same |
|
AZ
|
Base Rate |
$3,150.07
|
Same |
|
CA
|
Base Rate |
$3,150.07
|
Same |
|
CO
|
Base Rate |
$3,150.07
|
Same |
|
CT
|
Base Rate |
$3,150.07
|
Same |
|
DC
|
Base Rate |
$3,150.07
|
Same |
|
DE
|
Base Rate |
$3,150.07
|
Same |
|
FL
|
Base Rate |
$3,150.07
|
Same |
|
GA
|
Base Rate |
$3,150.07
|
Same |
|
HI
|
Base Rate |
$3,150.07
|
Same |
|
IA
|
Base Rate |
$3,150.07
|
Same |
|
ID
|
Base Rate |
$3,150.07
|
Same |
|
IL
|
Base Rate |
$3,150.07
|
Same |
|
IN
|
Base Rate |
$3,150.07
|
Same |
|
KS
|
Base Rate |
$3,150.07
|
Same |
|
KY
|
Base Rate |
$3,150.07
|
Same |
|
LA
|
Base Rate |
$3,150.07
|
Same |
|
MA
|
Base Rate |
$3,150.07
|
Same |
|
MD
|
Base Rate |
$3,150.07
|
Same |
|
ME
|
Base Rate |
$3,150.07
|
Same |
|
MI
|
Base Rate |
$3,150.07
|
Same |
|
MN
|
Base Rate |
$3,150.07
|
Same |
|
MO
|
Base Rate |
$3,150.07
|
Same |
|
MS
|
Base Rate |
$3,150.07
|
Same |
|
MT
|
Base Rate |
$3,150.07
|
Same |
|
NC
|
Base Rate |
$3,150.07
|
Same |
|
ND
|
Base Rate |
$3,150.07
|
Same |
|
NE
|
Base Rate |
$3,150.07
|
Same |
|
NH
|
Base Rate |
$3,150.07
|
Same |
|
NJ
|
Base Rate |
$3,150.07
|
Same |
|
NM
|
Base Rate |
$3,150.07
|
Same |
|
NV
|
Base Rate |
$3,150.07
|
Same |
|
NY
|
Base Rate |
$3,150.07
|
Same |
|
OH
|
Base Rate |
$3,150.07
|
Same |
|
OK
|
Base Rate |
$3,150.07
|
Same |
|
OR
|
Base Rate |
$3,150.07
|
Same |
|
PA
|
Base Rate |
$3,150.07
|
Same |
|
PR
|
Base Rate |
$3,150.07
|
Same |
|
RI
|
Base Rate |
$3,150.07
|
Same |
|
SC
|
Base Rate |
$3,150.07
|
Same |
|
SD
|
Base Rate |
$3,150.07
|
Same |
|
TN
|
Base Rate |
$3,150.07
|
Same |
|
TX
|
Base Rate |
$3,150.07
|
Same |
|
UT
|
Base Rate |
$3,150.07
|
Same |
|
VA
|
Base Rate |
$3,150.07
|
Same |
|
VI
|
Base Rate |
$3,150.07
|
Same |
|
VT
|
Base Rate |
$3,150.07
|
Same |
|
WA
|
Base Rate |
$3,150.07
|
Same |
|
WI
|
Base Rate |
$3,150.07
|
Same |
|
WV
|
Base Rate |
$3,150.07
|
Same |
|
WY
|
Base Rate |
$3,150.07
|
Same |