L8701
Prosthetics & Orthotics
53 States
Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated
Short Desc
Ewh s/d uprt micro sensor
Coverage determined by local carrier discretion.
Added Date
2019-01-01
Effective From
2024-01-01
National Floor
$31,473.12
National Ceiling
$41,964.16
Fee Schedule Rates
Effective Jan 2026Official Medicare DMEPOS pricing for 2026.
| State | Modifier | Non-Rural | Rural |
|---|---|---|---|
|
AK
|
Base Rate |
$34,970.13
|
Same |
|
AL
|
Base Rate |
$34,970.13
|
Same |
|
AR
|
Base Rate |
$34,970.13
|
Same |
|
AZ
|
Base Rate |
$34,970.13
|
Same |
|
CA
|
Base Rate |
$34,970.13
|
Same |
|
CO
|
Base Rate |
$34,970.13
|
Same |
|
CT
|
Base Rate |
$34,970.13
|
Same |
|
DC
|
Base Rate |
$34,970.13
|
Same |
|
DE
|
Base Rate |
$34,970.13
|
Same |
|
FL
|
Base Rate |
$34,970.13
|
Same |
|
GA
|
Base Rate |
$34,970.13
|
Same |
|
HI
|
Base Rate |
$34,970.13
|
Same |
|
IA
|
Base Rate |
$34,970.13
|
Same |
|
ID
|
Base Rate |
$34,970.13
|
Same |
|
IL
|
Base Rate |
$34,970.13
|
Same |
|
IN
|
Base Rate |
$34,970.13
|
Same |
|
KS
|
Base Rate |
$34,970.13
|
Same |
|
KY
|
Base Rate |
$34,970.13
|
Same |
|
LA
|
Base Rate |
$34,970.13
|
Same |
|
MA
|
Base Rate |
$34,970.13
|
Same |
|
MD
|
Base Rate |
$34,970.13
|
Same |
|
ME
|
Base Rate |
$34,970.13
|
Same |
|
MI
|
Base Rate |
$34,970.13
|
Same |
|
MN
|
Base Rate |
$34,970.13
|
Same |
|
MO
|
Base Rate |
$34,970.13
|
Same |
|
MS
|
Base Rate |
$34,970.13
|
Same |
|
MT
|
Base Rate |
$34,970.13
|
Same |
|
NC
|
Base Rate |
$34,970.13
|
Same |
|
ND
|
Base Rate |
$34,970.13
|
Same |
|
NE
|
Base Rate |
$34,970.13
|
Same |
|
NH
|
Base Rate |
$34,970.13
|
Same |
|
NJ
|
Base Rate |
$34,970.13
|
Same |
|
NM
|
Base Rate |
$34,970.13
|
Same |
|
NV
|
Base Rate |
$34,970.13
|
Same |
|
NY
|
Base Rate |
$34,970.13
|
Same |
|
OH
|
Base Rate |
$34,970.13
|
Same |
|
OK
|
Base Rate |
$34,970.13
|
Same |
|
OR
|
Base Rate |
$34,970.13
|
Same |
|
PA
|
Base Rate |
$34,970.13
|
Same |
|
PR
|
Base Rate |
$34,970.13
|
Same |
|
RI
|
Base Rate |
$34,970.13
|
Same |
|
SC
|
Base Rate |
$34,970.13
|
Same |
|
SD
|
Base Rate |
$34,970.13
|
Same |
|
TN
|
Base Rate |
$34,970.13
|
Same |
|
TX
|
Base Rate |
$34,970.13
|
Same |
|
UT
|
Base Rate |
$34,970.13
|
Same |
|
VA
|
Base Rate |
$34,970.13
|
Same |
|
VI
|
Base Rate |
$34,970.13
|
Same |
|
VT
|
Base Rate |
$34,970.13
|
Same |
|
WA
|
Base Rate |
$34,970.13
|
Same |
|
WI
|
Base Rate |
$34,970.13
|
Same |
|
WV
|
Base Rate |
$34,970.13
|
Same |
|
WY
|
Base Rate |
$34,970.13
|
Same |