L8042
Prosthetics & Orthotics
159 States
Orbital prosthesis, provided by a non-physician
Short Desc
Orbital prosthesis
Coverage determined by local carrier discretion.
Added Date
2001-01-01
Effective From
2001-01-01
National Floor
$3,689.75
National Ceiling
$4,919.66
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$4,569.01
|
Same |
|
AK
|
KM |
$4,340.59
|
Same |
|
AK
|
KN |
$1,827.59
|
Same |
|
AL
|
Base Rate |
$4,052.70
|
Same |
|
AL
|
KM |
$3,850.07
|
Same |
|
AL
|
KN |
$1,621.08
|
Same |
|
AR
|
Base Rate |
$3,996.01
|
Same |
|
AR
|
KM |
$3,796.17
|
Same |
|
AR
|
KN |
$1,598.41
|
Same |
|
AZ
|
Base Rate |
$4,263.82
|
Same |
|
AZ
|
KM |
$4,050.64
|
Same |
|
AZ
|
KN |
$1,705.54
|
Same |
|
CA
|
Base Rate |
$4,263.82
|
Same |
|
CA
|
KM |
$4,050.64
|
Same |
|
CA
|
KN |
$1,705.54
|
Same |
|
CO
|
Base Rate |
$3,894.33
|
Same |
|
CO
|
KM |
$3,699.59
|
Same |
|
CO
|
KN |
$1,557.72
|
Same |
|
CT
|
Base Rate |
$4,356.33
|
Same |
|
CT
|
KM |
$4,138.50
|
Same |
|
CT
|
KN |
$1,742.54
|
Same |
|
DC
|
Base Rate |
$4,148.60
|
Same |
|
DC
|
KM |
$3,941.15
|
Same |
|
DC
|
KN |
$1,659.45
|
Same |
|
DE
|
Base Rate |
$4,148.60
|
Same |
|
DE
|
KM |
$3,941.15
|
Same |
|
DE
|
KN |
$1,659.45
|
Same |
|
FL
|
Base Rate |
$4,052.70
|
Same |
|
FL
|
KM |
$3,850.07
|
Same |
|
FL
|
KN |
$1,621.08
|
Same |
|
GA
|
Base Rate |
$4,052.70
|
Same |
|
GA
|
KM |
$3,850.07
|
Same |
|
GA
|
KN |
$1,621.08
|
Same |
|
HI
|
Base Rate |
$4,374.53
|
Same |
|
HI
|
KM |
$4,155.80
|
Same |
|
HI
|
KN |
$1,749.80
|
Same |
|
IA
|
Base Rate |
$3,809.10
|
Same |
|
IA
|
KM |
$3,618.60
|
Same |
|
IA
|
KN |
$1,523.65
|
Same |
|
ID
|
Base Rate |
$4,069.63
|
Same |
|
ID
|
KM |
$3,866.13
|
Same |
|
ID
|
KN |
$1,627.86
|
Same |
|
IL
|
Base Rate |
$4,133.93
|
Same |
|
IL
|
KM |
$3,927.24
|
Same |
|
IL
|
KN |
$1,653.59
|
Same |
|
IN
|
Base Rate |
$4,133.93
|
Same |
|
IN
|
KM |
$3,927.24
|
Same |
|
IN
|
KN |
$1,653.59
|
Same |
|
KS
|
Base Rate |
$3,809.10
|
Same |
|
KS
|
KM |
$3,618.60
|
Same |
|
KS
|
KN |
$1,523.65
|
Same |
|
KY
|
Base Rate |
$4,052.70
|
Same |
|
KY
|
KM |
$3,850.07
|
Same |
|
KY
|
KN |
$1,621.08
|
Same |
|
LA
|
Base Rate |
$3,996.01
|
Same |
|
LA
|
KM |
$3,796.17
|
Same |
|
LA
|
KN |
$1,598.41
|
Same |
|
MA
|
Base Rate |
$4,356.33
|
Same |
|
MA
|
KM |
$4,138.50
|
Same |
|
MA
|
KN |
$1,742.54
|
Same |
|
MD
|
Base Rate |
$4,148.60
|
Same |
|
MD
|
KM |
$3,941.15
|
Same |
|
MD
|
KN |
$1,659.45
|
Same |
|
ME
|
Base Rate |
$4,356.33
|
Same |
|
ME
|
KM |
$4,138.50
|
Same |
|
ME
|
KN |
$1,742.54
|
Same |
|
MI
|
Base Rate |
$4,133.93
|
Same |
|
MI
|
KM |
$3,927.24
|
Same |
|
MI
|
KN |
$1,653.59
|
Same |
|
MN
|
Base Rate |
$4,133.93
|
Same |
|
MN
|
KM |
$3,927.24
|
Same |
|
MN
|
KN |
$1,653.59
|
Same |
|
MO
|
Base Rate |
$3,809.10
|
Same |
|
MO
|
KM |
$3,618.60
|
Same |
|
MO
|
KN |
$1,523.65
|
Same |
|
MS
|
Base Rate |
$4,052.70
|
Same |
|
MS
|
KM |
$3,850.07
|
Same |
|
MS
|
KN |
$1,621.08
|
Same |
|
MT
|
Base Rate |
$3,894.33
|
Same |
|
MT
|
KM |
$3,699.59
|
Same |
|
MT
|
KN |
$1,557.72
|
Same |
|
NC
|
Base Rate |
$4,052.70
|
Same |
|
NC
|
KM |
$3,850.07
|
Same |
|
NC
|
KN |
$1,621.08
|
Same |
|
ND
|
Base Rate |
$3,894.33
|
Same |
|
ND
|
KM |
$3,699.59
|
Same |
|
ND
|
KN |
$1,557.72
|
Same |
|
NE
|
Base Rate |
$3,809.10
|
Same |
|
NE
|
KM |
$3,618.60
|
Same |
|
NE
|
KN |
$1,523.65
|
Same |
|
NH
|
Base Rate |
$4,356.33
|
Same |
|
NH
|
KM |
$4,138.50
|
Same |
|
NH
|
KN |
$1,742.54
|
Same |
|
NJ
|
Base Rate |
$4,524.39
|
Same |
|
NJ
|
KM |
$4,298.14
|
Same |
|
NJ
|
KN |
$1,809.75
|
Same |
|
NM
|
Base Rate |
$3,996.01
|
Same |
|
NM
|
KM |
$3,796.17
|
Same |
|
NM
|
KN |
$1,598.41
|
Same |
|
NV
|
Base Rate |
$4,263.82
|
Same |
|
NV
|
KM |
$4,050.64
|
Same |
|
NV
|
KN |
$1,705.54
|
Same |
|
NY
|
Base Rate |
$4,524.39
|
Same |
|
NY
|
KM |
$4,298.14
|
Same |
|
NY
|
KN |
$1,809.75
|
Same |
|
OH
|
Base Rate |
$4,133.93
|
Same |
|
OH
|
KM |
$3,927.24
|
Same |
|
OH
|
KN |
$1,653.59
|
Same |
|
OK
|
Base Rate |
$3,996.01
|
Same |
|
OK
|
KM |
$3,796.17
|
Same |
|
OK
|
KN |
$1,598.41
|
Same |
|
OR
|
Base Rate |
$4,069.63
|
Same |
|
OR
|
KM |
$3,866.13
|
Same |
|
OR
|
KN |
$1,627.86
|
Same |
|
PA
|
Base Rate |
$4,148.60
|
Same |
|
PA
|
KM |
$3,941.15
|
Same |
|
PA
|
KN |
$1,659.45
|
Same |
|
PR
|
Base Rate |
$3,835.15
|
Same |
|
PR
|
KM |
$3,643.45
|
Same |
|
PR
|
KN |
$1,534.04
|
Same |
|
RI
|
Base Rate |
$4,356.33
|
Same |
|
RI
|
KM |
$4,138.50
|
Same |
|
RI
|
KN |
$1,742.54
|
Same |
|
SC
|
Base Rate |
$4,052.70
|
Same |
|
SC
|
KM |
$3,850.07
|
Same |
|
SC
|
KN |
$1,621.08
|
Same |
|
SD
|
Base Rate |
$3,894.33
|
Same |
|
SD
|
KM |
$3,699.59
|
Same |
|
SD
|
KN |
$1,557.72
|
Same |
|
TN
|
Base Rate |
$4,052.70
|
Same |
|
TN
|
KM |
$3,850.07
|
Same |
|
TN
|
KN |
$1,621.08
|
Same |
|
TX
|
Base Rate |
$3,996.01
|
Same |
|
TX
|
KM |
$3,796.17
|
Same |
|
TX
|
KN |
$1,598.41
|
Same |
|
UT
|
Base Rate |
$3,894.33
|
Same |
|
UT
|
KM |
$3,699.59
|
Same |
|
UT
|
KN |
$1,557.72
|
Same |
|
VA
|
Base Rate |
$4,148.60
|
Same |
|
VA
|
KM |
$3,941.15
|
Same |
|
VA
|
KN |
$1,659.45
|
Same |
|
VI
|
Base Rate |
$4,844.80
|
Same |
|
VI
|
KM |
$4,602.58
|
Same |
|
VI
|
KN |
$1,937.90
|
Same |
|
VT
|
Base Rate |
$4,356.33
|
Same |
|
VT
|
KM |
$4,138.50
|
Same |
|
VT
|
KN |
$1,742.54
|
Same |
|
WA
|
Base Rate |
$4,069.63
|
Same |
|
WA
|
KM |
$3,866.13
|
Same |
|
WA
|
KN |
$1,627.86
|
Same |
|
WI
|
Base Rate |
$4,133.93
|
Same |
|
WI
|
KM |
$3,927.24
|
Same |
|
WI
|
KN |
$1,653.59
|
Same |
|
WV
|
Base Rate |
$4,148.60
|
Same |
|
WV
|
KM |
$3,941.15
|
Same |
|
WV
|
KN |
$1,659.45
|
Same |
|
WY
|
Base Rate |
$3,894.33
|
Same |
|
WY
|
KM |
$3,699.59
|
Same |
|
WY
|
KN |
$1,557.72
|
Same |