L8043
Prosthetics & Orthotics
159 States
Upper facial prosthesis, provided by a non-physician
Short Desc
Upper facial prosthesis
Coverage determined by local carrier discretion.
Added Date
2001-01-01
Effective From
2001-01-01
National Floor
$4,132.53
National Ceiling
$5,510.04
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$5,117.31
|
Same |
|
AK
|
KM |
$4,861.43
|
Same |
|
AK
|
KN |
$2,046.90
|
Same |
|
AL
|
Base Rate |
$4,539.05
|
Same |
|
AL
|
KM |
$4,312.05
|
Same |
|
AL
|
KN |
$1,815.60
|
Same |
|
AR
|
Base Rate |
$4,475.52
|
Same |
|
AR
|
KM |
$4,251.77
|
Same |
|
AR
|
KN |
$1,790.23
|
Same |
|
AZ
|
Base Rate |
$4,775.50
|
Same |
|
AZ
|
KM |
$4,536.69
|
Same |
|
AZ
|
KN |
$1,910.16
|
Same |
|
CA
|
Base Rate |
$4,775.50
|
Same |
|
CA
|
KM |
$4,536.69
|
Same |
|
CA
|
KN |
$1,910.16
|
Same |
|
CO
|
Base Rate |
$4,361.65
|
Same |
|
CO
|
KM |
$4,143.54
|
Same |
|
CO
|
KN |
$1,744.62
|
Same |
|
CT
|
Base Rate |
$4,879.09
|
Same |
|
CT
|
KM |
$4,635.15
|
Same |
|
CT
|
KN |
$1,951.61
|
Same |
|
DC
|
Base Rate |
$4,646.49
|
Same |
|
DC
|
KM |
$4,414.16
|
Same |
|
DC
|
KN |
$1,858.57
|
Same |
|
DE
|
Base Rate |
$4,646.49
|
Same |
|
DE
|
KM |
$4,414.16
|
Same |
|
DE
|
KN |
$1,858.57
|
Same |
|
FL
|
Base Rate |
$4,539.05
|
Same |
|
FL
|
KM |
$4,312.05
|
Same |
|
FL
|
KN |
$1,815.60
|
Same |
|
GA
|
Base Rate |
$4,539.05
|
Same |
|
GA
|
KM |
$4,312.05
|
Same |
|
GA
|
KN |
$1,815.60
|
Same |
|
HI
|
Base Rate |
$4,899.45
|
Same |
|
HI
|
KM |
$4,654.46
|
Same |
|
HI
|
KN |
$1,959.80
|
Same |
|
IA
|
Base Rate |
$4,266.20
|
Same |
|
IA
|
KM |
$4,052.87
|
Same |
|
IA
|
KN |
$1,706.46
|
Same |
|
ID
|
Base Rate |
$4,557.98
|
Same |
|
ID
|
KM |
$4,330.09
|
Same |
|
ID
|
KN |
$1,823.20
|
Same |
|
IL
|
Base Rate |
$4,630.01
|
Same |
|
IL
|
KM |
$4,398.54
|
Same |
|
IL
|
KN |
$1,852.02
|
Same |
|
IN
|
Base Rate |
$4,630.01
|
Same |
|
IN
|
KM |
$4,398.54
|
Same |
|
IN
|
KN |
$1,852.02
|
Same |
|
KS
|
Base Rate |
$4,266.20
|
Same |
|
KS
|
KM |
$4,052.87
|
Same |
|
KS
|
KN |
$1,706.46
|
Same |
|
KY
|
Base Rate |
$4,539.05
|
Same |
|
KY
|
KM |
$4,312.05
|
Same |
|
KY
|
KN |
$1,815.60
|
Same |
|
LA
|
Base Rate |
$4,475.52
|
Same |
|
LA
|
KM |
$4,251.77
|
Same |
|
LA
|
KN |
$1,790.23
|
Same |
|
MA
|
Base Rate |
$4,879.09
|
Same |
|
MA
|
KM |
$4,635.15
|
Same |
|
MA
|
KN |
$1,951.61
|
Same |
|
MD
|
Base Rate |
$4,646.49
|
Same |
|
MD
|
KM |
$4,414.16
|
Same |
|
MD
|
KN |
$1,858.57
|
Same |
|
ME
|
Base Rate |
$4,879.09
|
Same |
|
ME
|
KM |
$4,635.15
|
Same |
|
ME
|
KN |
$1,951.61
|
Same |
|
MI
|
Base Rate |
$4,630.01
|
Same |
|
MI
|
KM |
$4,398.54
|
Same |
|
MI
|
KN |
$1,852.02
|
Same |
|
MN
|
Base Rate |
$4,630.01
|
Same |
|
MN
|
KM |
$4,398.54
|
Same |
|
MN
|
KN |
$1,852.02
|
Same |
|
MO
|
Base Rate |
$4,266.20
|
Same |
|
MO
|
KM |
$4,052.87
|
Same |
|
MO
|
KN |
$1,706.46
|
Same |
|
MS
|
Base Rate |
$4,539.05
|
Same |
|
MS
|
KM |
$4,312.05
|
Same |
|
MS
|
KN |
$1,815.60
|
Same |
|
MT
|
Base Rate |
$4,361.65
|
Same |
|
MT
|
KM |
$4,143.54
|
Same |
|
MT
|
KN |
$1,744.62
|
Same |
|
NC
|
Base Rate |
$4,539.05
|
Same |
|
NC
|
KM |
$4,312.05
|
Same |
|
NC
|
KN |
$1,815.60
|
Same |
|
ND
|
Base Rate |
$4,361.65
|
Same |
|
ND
|
KM |
$4,143.54
|
Same |
|
ND
|
KN |
$1,744.62
|
Same |
|
NE
|
Base Rate |
$4,266.20
|
Same |
|
NE
|
KM |
$4,052.87
|
Same |
|
NE
|
KN |
$1,706.46
|
Same |
|
NH
|
Base Rate |
$4,879.09
|
Same |
|
NH
|
KM |
$4,635.15
|
Same |
|
NH
|
KN |
$1,951.61
|
Same |
|
NJ
|
Base Rate |
$5,067.31
|
Same |
|
NJ
|
KM |
$4,813.90
|
Same |
|
NJ
|
KN |
$2,026.95
|
Same |
|
NM
|
Base Rate |
$4,475.52
|
Same |
|
NM
|
KM |
$4,251.77
|
Same |
|
NM
|
KN |
$1,790.23
|
Same |
|
NV
|
Base Rate |
$4,775.50
|
Same |
|
NV
|
KM |
$4,536.69
|
Same |
|
NV
|
KN |
$1,910.16
|
Same |
|
NY
|
Base Rate |
$5,067.31
|
Same |
|
NY
|
KM |
$4,813.90
|
Same |
|
NY
|
KN |
$2,026.95
|
Same |
|
OH
|
Base Rate |
$4,630.01
|
Same |
|
OH
|
KM |
$4,398.54
|
Same |
|
OH
|
KN |
$1,852.02
|
Same |
|
OK
|
Base Rate |
$4,475.52
|
Same |
|
OK
|
KM |
$4,251.77
|
Same |
|
OK
|
KN |
$1,790.23
|
Same |
|
OR
|
Base Rate |
$4,557.98
|
Same |
|
OR
|
KM |
$4,330.09
|
Same |
|
OR
|
KN |
$1,823.20
|
Same |
|
PA
|
Base Rate |
$4,646.49
|
Same |
|
PA
|
KM |
$4,414.16
|
Same |
|
PA
|
KN |
$1,858.57
|
Same |
|
PR
|
Base Rate |
$4,295.38
|
Same |
|
PR
|
KM |
$4,080.61
|
Same |
|
PR
|
KN |
$1,718.16
|
Same |
|
RI
|
Base Rate |
$4,879.09
|
Same |
|
RI
|
KM |
$4,635.15
|
Same |
|
RI
|
KN |
$1,951.61
|
Same |
|
SC
|
Base Rate |
$4,539.05
|
Same |
|
SC
|
KM |
$4,312.05
|
Same |
|
SC
|
KN |
$1,815.60
|
Same |
|
SD
|
Base Rate |
$4,361.65
|
Same |
|
SD
|
KM |
$4,143.54
|
Same |
|
SD
|
KN |
$1,744.62
|
Same |
|
TN
|
Base Rate |
$4,539.05
|
Same |
|
TN
|
KM |
$4,312.05
|
Same |
|
TN
|
KN |
$1,815.60
|
Same |
|
TX
|
Base Rate |
$4,475.52
|
Same |
|
TX
|
KM |
$4,251.77
|
Same |
|
TX
|
KN |
$1,790.23
|
Same |
|
UT
|
Base Rate |
$4,361.65
|
Same |
|
UT
|
KM |
$4,143.54
|
Same |
|
UT
|
KN |
$1,744.62
|
Same |
|
VA
|
Base Rate |
$4,646.49
|
Same |
|
VA
|
KM |
$4,414.16
|
Same |
|
VA
|
KN |
$1,858.57
|
Same |
|
VI
|
Base Rate |
$5,426.13
|
Same |
|
VI
|
KM |
$5,154.84
|
Same |
|
VI
|
KN |
$2,170.48
|
Same |
|
VT
|
Base Rate |
$4,879.09
|
Same |
|
VT
|
KM |
$4,635.15
|
Same |
|
VT
|
KN |
$1,951.61
|
Same |
|
WA
|
Base Rate |
$4,557.98
|
Same |
|
WA
|
KM |
$4,330.09
|
Same |
|
WA
|
KN |
$1,823.20
|
Same |
|
WI
|
Base Rate |
$4,630.01
|
Same |
|
WI
|
KM |
$4,398.54
|
Same |
|
WI
|
KN |
$1,852.02
|
Same |
|
WV
|
Base Rate |
$4,646.49
|
Same |
|
WV
|
KM |
$4,414.16
|
Same |
|
WV
|
KN |
$1,858.57
|
Same |
|
WY
|
Base Rate |
$4,361.65
|
Same |
|
WY
|
KM |
$4,143.54
|
Same |
|
WY
|
KN |
$1,744.62
|
Same |