Florida Medicaid’s 2026 DME fee schedule, effective July 1, 2026, outlines reimbursement rates, HCPCS codes, rental rules, service limits, and prior authorization requirements for durable medical equipment and medical supplies. Use this guide to check applicable fees and billing requirements before submitting claims and help reduce avoidable denials.
How to Use the 2026 Florida Medicaid DME Fee Schedule
Before billing, verify the HCPCS code, maximum fee, coverage requirements, service limits, rental or purchase rules, and prior authorization requirements.
Example Florida Medicaid DME Rates
| HCPCS code | Equipment | Maximum fee |
|---|---|---|
| E0570 | Nebulizer | $114.49 |
| E0143 | Folding walker | $92.54 |
| E0260 | Semi-electric hospital bed | $1,150.10 |
| K0001 | Standard manual wheelchair | $380.16 |
Understanding Fee Schedule Columns
The schedule identifies HCPCS codes, age ranges, maximum fees, rental requirements, billing units, and limits. It also flags items requiring prior authorization (PA), manual pricing (MP), or review by report (BR). Bundled codes (BC) indicate supplies included in rental reimbursement.
What DME Providers Should Check Before Billing
- Confirm the HCPCS code and recipient’s age range.
- Verify reimbursement rates and rental or purchase requirements.
- Check unit limits and replacement frequencies.
- Identify authorization, manual pricing, and medical review requirements.
- Avoid separately billing supplies included in bundled rental payments.
Florida Medicaid DME Provider Fee Schedule 2026
Accurate billing requires correct coding, medical necessity documentation, and compliance with applicable authorization and service limits. Review the official Florida Medicaid Provider Fee Schedules for current, code-specific requirements.
| Column | Field | Definition |
|---|---|---|
| A | HCPCS Code | Identifies the Healthcare Common Procedure Coding System (HCPCS) code associated with the service or item. |
| B | Age Range | Specifies the recipient age range covered for the procedure code. |
| C | Orthopedic Specialty (OS) | Codes marked OS are reimbursable to physicians with an orthopedic specialty and DME providers. Codes without OS are reimbursable only to DME providers. |
| D | Maximum Fee | Lists the maximum Medicaid reimbursement for the DME item, medical supply, orthotic, or prosthetic device. Unless otherwise specified, the rate applies per unilateral item, single item, or unit. Ostomy supply rates generally apply per stoma or fistula unless otherwise specified. A rate of $0.00 indicates a non-classified code that requires prior authorization or a By Report claim, as indicated in the schedule. |
| E | Rental Only (RO) | Indicates that the equipment remains the provider’s property and is reimbursed through a monthly rental fee during the authorized medically necessary period. |
| F | Rental Amount | Specifies the monthly reimbursement amount for rental-only and rent-to-purchase items. |
| G | Daily Rental (DR) | Indicates that rental reimbursement is calculated daily rather than monthly. |
| H | Units | Specifies the number of units that may be billed for dates of service within the same month. Providers may bill up to a one-month supply on a single billing date, based on the recipient’s medical need. |
| I | Manually Priced (MP) | Indicates that reimbursement must be negotiated between the provider and the Agency’s contracted Quality Improvement Organization (QIO). |
| J | Bundled Code (BC) | Indicates that rental reimbursement includes the supplies required to operate the equipment throughout the rental period. These supplies cannot be billed separately and must be replaced when necessary. |
| K | By Report (BR) | Identifies a non-classified procedure code requiring medical review for approval and appropriate pricing. |
| L | Prior Authorization (PA) | Identifies services requiring authorization from the Agency’s fee-for-service QIO vendor before the service is performed. This includes requests to exceed limits or request services not listed on the fee schedule, such as E1399. |
| M | Time-Limited Rate | Identifies codes assigned a temporary reimbursement rate because of specific circumstances, such as a state of emergency or supply shortage. |
| N | Limit | Specifies the maximum limit applicable to the procedure code. |
Ostomy, wound care & diabetic
A4206–A4216: Ostomy, Wound Care, and Diabetic Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4206 | 0–999 | 0.31 | — | — | 60 | 720 per year |
| A4207 | 0–999 | 0.31 | — | — | 60 | 720 per year |
| A4208 | 0–999 | 0.31 | — | — | 60 | 720 per year |
| A4209 | 0–999 | 0.31 | — | — | 60 | 720 per year |
| A4213 | 0–999 | 2.08 | — | — | 31 | 372 per year |
| A4215 | 0–999 | 0.20 | — | — | 100 | 1,200 per year |
| A4216 | 0–999 | 0.36 | — | — | 150 | 150 per month |
A4217–A4223: Infusion and Medical Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4217 | 0–20 | 2.61 | — | — | 1 | 31 units per month |
| A4221 | 0–20 | 18.58 | — | — | 1 | 52 per year |
| A4222 | 0–20 | 36.90 | — | — | 7 | Up to 365 per year, based on medical necessity |
| A4223 | 0–999 | 36.90 | — | — | 1 | 52 per year |
A4230–A4250: Diabetic Testing Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4230 | 0–999 | 166.87 | — | — | 1 | 12 boxes per year |
| A4231 | 0–999 | 93.48 | — | — | 1 | 12 boxes per year |
| A4232 | 0–999 | 62.06 | — | — | 1 | 12 boxes per year |
| A4244 | 0–999 | 0.84 | — | — | 12 | 144 per year |
| A4245 | 0–999 | 2.08 | — | — | 2 | 24 per year |
| A4246 | 0–20 | 5.20 | — | — | 3 | 36 per year |
| A4247 | 0–999 | 7.81 | — | — | 2 | 2 boxes per month |
| A4250 | 0–999 | 10.62 | — | — | 2 | 2 boxes per month |
A4265–A4346: Catheters and Urinary Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4265 | 0–20 | 4.16 | — | — | 6 | 72 per year |
| A4280 | 0–999 | 4.03 | — | — | 5 | 5 per month |
| A4310 | 0–20 | 4.32 | — | — | 2 | 24 per year |
| A4311 | 0–999 | 4.79 | — | — | 3 | 36 per year |
| A4312 | 0–999 | 16.96 | — | — | 3 | 36 per year |
| A4313 | 0–999 | 11.15 | — | — | 3 | 36 per year |
| A4314 | 0–20 | 11.45 | — | — | 2 | 24 per year |
| A4315 | 0–20 | 11.45 | — | — | 2 | 24 per year |
| A4316 | 0–20 | 11.45 | — | — | 2 | 24 per year |
| A4320 | 0–20 | 5.26 | — | — | 31 | 372 per year |
| A4322 | 0–20 | 2.31 | — | — | 12 | 144 per year |
| A4326 | 0–20 | 8.95 | — | — | 31 | 372 per year |
| A4327 | 0–20 | 17.28 | — | — | 1 | 1 per year |
| A4328 | 0–20 | 5.37 | — | — | 2 | 24 per year |
| A4330 | 0–20 | 5.57 | — | — | 31 | 372 per year |
| A4331 | 0–999 | 1.80 | — | — | 31 | 372 per year |
| A4332 | 0–999 | 0.11 | — | — | 200 | 200 per month |
| A4333 | 0–999 | 2.61 | — | — | 31 | 31 per month |
| A4338 | 0–20 | 6.61 | — | — | 3 | 36 per year |
| A4340 | 0–20 | 7.18 | — | — | 3 | 36 per year |
| A4344 | 0–20 | 5.73 | — | — | 3 | 36 per year |
| A4346 | 0–20 | 9.37 | — | — | 3 | 36 per year |
A4349–A4395: Ostomy and Wound Care Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4349 | 0–999 | 1.78 | — | — | 35 | 35 per month |
| A4351 | 0–999 | 1.72 | — | — | 186 | 186 per month |
| A4352 | 0–999 | 1.97 | — | — | 186 | 186 per month |
| A4353 | 0–999 | 5.72 | — | — | 186 | 186 per month |
| A4354 | 0–20 | 4.16 | — | — | 3 | 36 per year |
| A4355 | 0–20 | 2.70 | — | — | 4 | 48 per year |
| A4356 | 0–20 | 37.47 | — | — | 1 | 1 per year |
| A4357 | 0–999 | 8.33 | — | — | 2 | 24 per year |
| A4358 | 0–999 | 3.65 | — | — | 5 | 60 per year |
| A4361 | 0–999 | 18.80 | — | — | 1 | 12 per year |
| A4362 | 0–999 | 3.12 | — | — | 20 | 240 per year |
| A4363 | 0–999 | 4.45 | — | — | 12 | 144 per year |
| A4364 | 0–999 | 2.29 | — | — | 4 | 48 per year |
| A4367 | 0–999 | 6.02 | — | — | 1 | 12 per year |
| A4368 | 0–999 | 0.21 | — | — | 200 | 200 per month |
| A4369 | 0–999 | 1.97 | — | — | 12 | 144 per year |
| A4371 | 0–999 | 2.98 | — | — | 12 | 144 per year |
| A4372 | 0–999 | 3.41 | — | — | 20 | 240 per year |
| A4373 | 0–999 | 5.14 | — | — | 31 | 372 per year |
| A4375 | 0–999 | 14.06 | — | — | 10 | 10 per month |
| A4376 | 0–999 | 38.95 | — | — | 10 | 10 per month |
| A4377 | 0–999 | 3.51 | — | — | 10 | 10 per month |
| A4378 | 0–999 | 25.17 | — | — | 10 | 10 per month |
| A4379 | 0–999 | 12.30 | — | — | 10 | 10 per month |
| A4380 | 0–999 | 30.56 | — | — | 20 | 240 per year |
| A4381 | 0–999 | 3.78 | — | — | 10 | 10 per month |
| A4382 | 0–999 | 20.15 | — | — | 10 | 10 per month |
| A4383 | 0–999 | 23.08 | — | — | 10 | 10 per month |
| A4384 | 0–999 | 7.88 | — | — | 10 | 10 per month |
| A4385 | 0–999 | 4.16 | — | — | 10 | 10 per month |
| A4387 | 0–999 | 3.28 | — | — | 10 | 10 per month |
| A4388 | 0–999 | 3.56 | — | — | 10 | 10 per month |
| A4389 | 0–999 | 5.09 | — | — | 10 | 10 per month |
| A4390 | 0–999 | 7.87 | — | — | 10 | 10 per month |
| A4391 | 0–999 | 5.78 | — | — | 10 | 10 per month |
| A4392 | 0–999 | 5.44 | — | — | 10 | 10 per month |
| A4393 | 0–999 | 7.51 | — | — | 10 | 10 per month |
| A4394 | 0–999 | 2.10 | — | — | 10 | 10 per month |
| A4395 | 0–999 | 0.04 | — | — | 31 | 31 per month |
A4396–A4456: Wound Dressings and Related Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4396 | 0–999 | 33.14 | — | — | 2 | 2 per month |
| A4398 | 0–999 | 24.98 | — | — | 2 | 24 per year |
| A4399 | 0–999 | 6.24 | — | — | 1 | 2 per year |
| A4400 | 0–999 | 34.01 | — | — | 1 | 6 per year |
| A4402 | 0–999 | 1.45 | — | — | 4 | 48 per year |
| A4404 | 0–999 | 1.38 | — | — | 31 | 372 per year |
| A4405 | 0–999 | 2.34 | — | — | 12 | 144 per year |
| A4406 | 0–999 | 3.94 | — | — | 12 | 144 per year |
| A4407 | 0–999 | 6.02 | — | — | 31 | 372 per year |
| A4408 | 0–999 | 6.78 | — | — | 31 | 372 per year |
| A4409 | 0–999 | 4.27 | — | — | 31 | 372 per year |
| A4410 | 0–999 | 6.20 | — | — | 31 | 372 per year |
| A4411 | 0–999 | 5.63 | — | — | 31 | 372 per year |
| A4412 | 0–999 | 3.22 | — | — | 31 | 31 per month |
| A4413 | 0–999 | 3.78 | — | — | 10 | 10 per month |
| A4414 | 0–999 | 3.38 | — | — | 31 | 372 per year |
| A4415 | 0–999 | 4.12 | — | — | 31 | 372 per year |
| A4416 | 0–999 | 1.89 | — | — | 31 | 31 per month |
| A4417 | 0–999 | 2.55 | — | — | 31 | 31 per month |
| A4418 | 0–999 | 1.24 | — | — | 31 | 31 per month |
| A4420 | 0–999 | 1.37 | — | — | 31 | 31 per month |
| A4421 | 0–999 | MP | — | — | 1 | 12 per year; PA |
| A4423 | 0–999 | 1.37 | — | — | 31 | 31 per month |
| A4424 | 0–999 | 3.26 | — | — | 31 | 31 per month |
| A4425 | 0–999 | 2.46 | — | — | 31 | 372 per year |
| A4426 | 0–999 | 1.62 | — | — | 31 | 372 per year |
| A4427 | 0–999 | 2.03 | — | — | 31 | 372 per year |
| A4428 | 0–999 | 4.47 | — | — | 31 | 372 per year |
| A4429 | 0–999 | 5.17 | — | — | 31 | 372 per year |
| A4430 | 0–999 | 5.86 | — | — | 31 | 372 per year |
| A4431 | 0–999 | 3.49 | — | — | 31 | 31 per month |
| A4432 | 0–999 | 2.47 | — | — | 31 | 31 per month |
| A4433 | 0–999 | 2.30 | — | — | 31 | 31 per month |
| A4434 | 0–999 | 2.59 | — | — | 31 | 372 per year |
| A4436 | 0–999 | 12.98 | — | — | 1 | 1 per month |
| A4437 | 0–999 | 12.98 | — | — | 1 | 1 per month |
| A4450 | 0–999 | 0.32 | — | — | 200 | 2,400 per year |
| A4452 | 0–999 | 0.43 | — | — | 200 | 2,400 per year |
| A4455 | 0–999 | 1.24 | — | — | 4 | 48 per year |
| A4456 | 0–999 | 0.18 | — | — | 100 | 100 per month |
A4554–A5200: Medical and Diabetic Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A4554 | 0–20 | 0.36 | — | — | 150 | 1,800 per year |
| A4561 | 0–999 | 14.44 | — | — | 10 | 10 per month |
| A4562 | 0–999 | 39.12 | — | — | 10 | 10 per month |
| A4640 | 0–20 | 36.43 | — | — | 1 | 1 per year |
| A4927 | 0–999 | 6.17 | — | — | 4 | 48 per year; TL |
| A4930 | 0–999 | 1.29 | — | — | 100 | 1,200 per year; TL |
| A5051 | 0–999 | 1.78 | — | — | 31 | 372 per year |
| A5052 | 0–999 | 1.36 | — | — | 31 | 372 per year |
| A5053 | 0–999 | 1.37 | — | — | 31 | 372 per year |
| A5054 | 0–999 | 1.37 | — | — | 31 | 372 per year |
| A5055 | 0–999 | 1.30 | — | — | 31 | 31 per month |
| A5056 | 0–999 | 6.14 | — | — | 1 | 10 per month |
| A5057 | 0–999 | 12.61 | — | — | 1 | 10 per month |
| A5061 | 0–999 | 2.34 | — | — | 31 | 372 per year |
| A5062 | 0–999 | 2.03 | — | — | 31 | 372 per year |
| A5063 | 0–999 | 2.03 | — | — | 31 | 372 per year |
| A5071 | 0–999 | 3.03 | — | — | 31 | 372 per year |
| A5072 | 0–999 | 2.46 | — | — | 31 | 372 per year |
| A5073 | 0–999 | 2.24 | — | — | 31 | 372 per year |
| A5081 | 0–999 | 2.69 | — | — | 1 | 6 per year |
| A5082 | 0–999 | 8.27 | — | — | 1 | 6 per year |
| A5093 | 0–999 | 1.66 | — | — | 10 | 120 per year |
| A5102 | 0–20 | 7.18 | — | — | 1 | 2 per year |
| A5105 | 0–20 | 15.45 | — | — | 1 | 2 per year |
| A5112 | 0–999 | 28.35 | — | — | 1 | 12 per year |
| A5113 | 0–20 | 4.81 | — | — | 1 | 4 per year |
| A5114 | 0–20 | 5.93 | — | — | 1 | 4 per year |
| A5120 | 0–999 | 0.18 | — | — | 50 | 600 per year |
| A5121 | 0–999 | 5.19 | — | — | 10 | 120 per year |
| A5122 | 0–999 | 10.53 | — | — | 10 | 120 per year |
| A5126 | 0–20 | 0.68 | — | — | 20 | 240 per year |
| A5131 | 0–999 | 11.03 | — | — | 3 | 3 per month |
| A5200 | 0–20 | 9.25 | — | — | 3 | 3 per month |
A6022–A6457: Wound Care and Related Medical Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A6022 | 0–999 | 17.21 | — | — | 31 | 31 per month |
| A6023 | 0–999 | 155.81 | — | — | 15 | 15 per month |
| A6024 | 0–999 | 5.06 | — | — | 31 | 31 per month |
| A6154 | 0–20 | 11.42 | — | — | 15 | 15 per month |
| A6196 | 0–20 | 6.02 | — | — | 31 | 31 per month |
| A6197 | 0–20 | 13.41 | — | — | 31 | 31 per month |
| A6199 | 0–20 | 4.33 | — | — | 31 | 31 per month |
| A6203 | 0–20 | 2.75 | — | — | 31 | 31 per month |
| A6204 | 0–20 | 5.11 | — | — | 31 | 31 per month |
| A6207 | 0–20 | 6.01 | — | — | 31 | 31 per month |
| A6209 | 0–20 | 6.14 | — | — | 31 | 31 per month |
| A6210 | 0–20 | 16.31 | — | — | 31 | 31 per month |
| A6211 | 0–20 | 24.04 | — | — | 31 | 31 per month |
| A6212 | 0–20 | 7.94 | — | — | 31 | 31 per month |
| A6214 | 0–20 | 8.43 | — | — | 31 | 31 per month |
| A6216 | 0–20 | 0.04 | — | — | 200 | 200 per month |
| A6219 | 0–20 | 0.78 | — | — | 62 | 62 per month |
| A6220 | 0–20 | 2.11 | — | — | 62 | 62 per month |
| A6222 | 0–20 | 1.75 | — | — | 31 | 31 per month |
| A6223 | 0–20 | 1.97 | — | — | 31 | 31 per month |
| A6224 | 0–20 | 2.96 | — | — | 31 | 31 per month |
| A6229 | 0–20 | 2.95 | — | — | 31 | 31 per month |
| A6231 | 0–999 | 3.82 | — | — | 31 | 31 per month |
| A6232 | 0–999 | 5.64 | — | — | 31 | 31 per month |
| A6233 | 0–999 | 15.71 | — | — | 31 | 31 per month |
| A6234 | 0–20 | 5.37 | — | — | 31 | 31 per month |
| A6235 | 0–20 | 13.78 | — | — | 31 | 31 per month |
| A6236 | 0–20 | 22.32 | — | — | 31 | 31 per month |
| A6237 | 0–20 | 6.48 | — | — | 31 | 31 per month |
| A6238 | 0–20 | 18.67 | — | — | 31 | 31 per month |
| A6240 | 0–20 | 10.03 | — | — | 31 | 31 per month |
| A6241 | 0–20 | 2.10 | — | — | 31 | 31 per month |
| A6242 | 0–20 | 4.97 | — | — | 31 | 31 per month |
| A6243 | 0–20 | 10.09 | — | — | 31 | 31 per month |
| A6244 | 0–20 | 32.14 | — | — | 31 | 31 per month |
| A6245 | 0–20 | 5.96 | — | — | 31 | 31 per month |
| A6246 | 0–20 | 8.10 | — | — | 31 | 31 per month |
| A6247 | 0–20 | 19.47 | — | — | 31 | 31 per month |
| A6248 | 0–20 | 13.31 | — | — | 15 | 15 per month |
| A6251 | 0–20 | 1.63 | — | — | 31 | 31 per month |
| A6252 | 0–20 | 2.66 | — | — | 31 | 31 per month |
| A6253 | 0–20 | 5.19 | — | — | 31 | 31 per month |
| A6254 | 0–20 | 0.97 | — | — | 31 | 31 per month |
| A6255 | 0–20 | 2.49 | — | — | 31 | 31 per month |
| A6257 | 0–999 | 1.23 | — | — | 31 | 31 per month |
| A6258 | 0–20 | 3.52 | — | — | 31 | 31 per month |
| A6259 | 0–20 | 8.96 | — | — | 31 | 31 per month |
| A6266 | 0–20 | 1.56 | — | — | 31 | 31 per month |
| A6402 | 0–20 | 0.11 | — | — | 200 | 200 per month |
| A6403 | 0–20 | 0.35 | — | — | 200 | 200 per month |
| A6441 | 0–20 | 0.43 | — | — | 31 | 31 per month |
| A6443 | 0–20 | 0.43 | — | — | 31 | 31 per month |
| A6444 | 0–20 | 0.43 | — | — | 31 | 31 per month |
| A6446 | 0–20 | 0.43 | — | — | 31 | 31 per month |
| A6447 | 0–20 | 0.43 | — | — | 31 | 31 per month |
| A6449 | 0–20 | 0.54 | — | — | 31 | 31 per month |
| A6450 | 0–20 | 0.54 | — | — | 31 | 31 per month |
| A6451 | 0–20 | 0.54 | — | — | 31 | 31 per month |
| A6452 | 0–20 | 0.54 | — | — | 31 | 31 per month |
| A6454 | 0–20 | 0.54 | — | — | 31 | 31 per month |
| A6456 | 0–20 | 9.76 | — | — | 31 | 31 per month |
| A6457 | 0–999 | 0.98 | — | — | 2 | 2 every 6 months |
A9276–A9900: Diabetic Monitoring and Miscellaneous Supplies
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| A9276 | 0–20 | 428.34 | — | — | 1 (per box) | 1 per month; PA |
| A9277 | 0–20 | 685.86 | — | — | 1 | 2 per year; PA |
| A9278 | 0–20 | 600.02 | — | — | 1 | 1 per year; PA |
| A9900 | 0–999 | MP | — | — | 1 | Medical necessity; PA |
T4521–T4535: Incontinence Supplies
| Code | Age | Maximum Fee ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|
| T4521* | 4–999 | 0.68 | 200 | Up to 200 per month | — |
| T4522* | 4–999 | 0.74 | 200 | Up to 200 per month | — |
| T4523* | 4–999 | 0.86 | 200 | Up to 200 per month | — |
| T4524* | 4–999 | 0.97 | 200 | Up to 200 per month | — |
| T4525* | 4–999 | 0.84 | 200 | Up to 200 per month | — |
| T4526* | 4–999 | 0.91 | 200 | Up to 200 per month | — |
| T4527* | 4–999 | 1.01 | 200 | Up to 200 per month | — |
| T4528* | 4–999 | 1.09 | 200 | Up to 200 per month | — |
| T4529* | 4–999 | 0.57 | 200 | Up to 200 per month | — |
| T4530* | 4–999 | 0.62 | 200 | Up to 200 per month | — |
| T4531* | 4–999 | 0.74 | 200 | Up to 200 per month | — |
| T4532* | 4–999 | 0.80 | 200 | Up to 200 per month | — |
| T4533* | 4–999 | 0.70 | 200 | Up to 200 per month | — |
| T4534* | 4–999 | 0.90 | 200 | Up to 200 per month | — |
| T4535* | 4–999 | 0.47 | 200 | Up to 200 per month | — |
T4543–T4544: Incontinence Supplies
| Code | Age | Maximum Fee ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|
| T4543* | 4–999 | 1.63 | 200 | Up to 200 per month | — |
| T4544* | 4–999 | 1.63 | 200 | Up to 200 per month | — |
Durable Medical Equipment
| Code | Age | Maximum Rate ($) | Daily Rental ($) | Rental Amount ($) | Rental Units | Time Limit |
|---|---|---|---|---|---|---|
| E0160 | 0–999 | 10.41 | — | — | 1 | 1 per 8 years |
| E0161 | 0–999 | 26.02 | — | — | 1 | 1 per 8 years |
| E0163 | 0–999 | 77.02 | — | — | 1 | 1 per 8 years |
| E0165 | 0–999 | 77.55 | — | — | 1 | 1 per 3 years |
| E0167 | 0–999 | 7.81 | — | — | 1 | 1 per year |
| E0168 | 0–999 | 123.93 | — | — | 1 | 1 per 3 years |
| E0171 | 0–999 | 24.83 | — | — | 1 | 1 per 3 years |
| E0181 | 0–20 | 161.38 | 16.14 | — | 1 | 1 per 3 years |
| E0184 | 0–20 | 296.68 | 29.67 | — | 1 | 1 per 3 years |
| E0185 | 0–999 | 130.10 | — | — | 1 | 1 per 2 years |
| E0186 | 0–20 | 197.75 | — | — | 1 | 1 per 3 years |
| E0187 | 0–20 | 197.75 | — | — | 1 | 1 per 3 years |
| E0189 | 0–20 | 83.26 | — | — | 1 | 1 per 2 years |
| E0190 | 0–20 | 28.32 | — | — | 1 | 1 per 3 years |
| E0191 | 0–20 | 7.29 | — | — | 2 | 4 per year |
| E0196 | 0–20 | 197.75 | — | — | 1 | 1 per 3 years |
| E0197 | 0–999 | 130.10 | — | — | 1 | 1 per 2 years |
| E0198 | 0–999 | 130.10 | — | — | 1 | 1 per 2 years |
| E0199 | 0–999 | 23.94 | — | — | 1 | 1 per 2 years |
| E0215 | 0–20 | 17.69 | — | — | 1 | 1 per lifetime |
| E0217 | 0–20 | 345.53 | — | — | 1 | 1 per 5 years |
| E0235 | 0–20 | 124.90 | 12.49 | — | 1 | 1 per 8 years |
| E0244 | 0–999 | 31.22 | — | — | 1 | 1 per 8 years |
| E0245 | 0–999 | 37.56 | — | — | 1 | 1 per 8 years |
| E0246 | 0–999 | 15.61 | — | — | 1 | 1 per 8 years |
| E0249 | 0–20 | 27.59 | — | — | 1 | 1 per year |
| E0275 | 0–999 | 8.33 | — | — | 1 | 1 per 4 years |
| E0276 | 0–999 | 9.89 | — | — | 1 | 1 per 4 years |
| E0325 | 0–999 | 6.77 | — | — | 1 | 1 per 4 years |
| E0326 | 0–999 | 9.37 | — | — | 1 | 1 per 4 years |
| E0784 | 0–999 | MP | — | — | 1 | Medical necessity; PA |
| E0968 | 0–999 | 15.31 | — | — | 1 | 2 per 4 years |
Nutritional
| Code | Age | Maximum Fee ($) | Rental Amount | Rental Units | Time Limit |
|---|---|---|---|---|---|
| B4034 | 0–999 | 5.03 | 31 | 31 per month | |
| B4035 | 0–20 | 9.23 | 31 | 31 per month | |
| B4036 | 0–999 | 6.55 | 31 | 31 per month | |
| B4081 | 0–20 | 15.61 | 8 | 96 per year | |
| B4082 | 0–20 | 12.49 | 8 | 96 per year | |
| B4083 | 0–20 | 1.57 | 15 | 180 per year | |
| B4087 | 0–999 | 15.61 | 2 | 24 per year | |
| B4088 | 0–999 | 123.40 | 1 | 6 per year | |
| B4149 | 0–20 | 1.63 | 930 | 930 per month | |
| B4150 | 0–999 | 0.67 | 930 | 930 per month | |
| B4150SC | 0–999 | 0.67 | 930 | 930 per month | |
| B4152 | 0–999 | 0.54 | 930 | 930 per month | |
| B4152SC | 0–999 | 0.54 | 930 | 930 per month | |
| B4153 | 0–999 | 2.19 | 930 | 930 per month | |
| B4153SC | 0–999 | 2.19 | 930 | 930 per month | |
| B4154 | 0–999 | 0.97 | 930 | 930 per month | |
| B4154SC | 0–999 | 0.97 | 930 | 930 per month | |
| B4155 | 0–999 | 0.79 | 930 | 930 per month | |
| B4155SC | 0–999 | 0.79 | 930 | 930 per month | |
| B4157 | 0–999 | BR | 930 | BR | 930 per month |
| B4157SC | 0–999 | BR | 930 | BR | 930 per month |
| B4160 | 0–20 | 0.84 | 930 | 930 per month | |
| B4160SC | 0–20 | 0.84 | 930 | 930 per month | |
| B4161 | 0–20 | BR | 930 | BR | 930 per month |
| B4161SC | 0–20 | BR | 930 | BR | 930 per month |
| B4162 | 0–20 | BR | 930 | BR | 930 per month |
| B4162SC | 0–20 | BR | 930 | BR | 930 per month |
| B9002 | 0–20 | 88.47 | RO | 1 | Medical necessity |
| B9004 | 0–20 | 88.47 | RO | 1 | Medical necessity |
| B9998 | 0–20 | MP | 10 | 120 per year | PA |
| E0776 | 0–20 | 114.49 | 11.45 | 1 per 8 years | |
| E0779 | 0–20 | 12.60 | RO | 1 | Medical necessity |
| E0780 | 0–20 | 8.49 | RO | 1 | Medical necessity |
Durable Medical Equipment (Rental)
| Code | Age | Maximum Fee ($) | Rental Only | Rental Amount | Daily Rental Units | Bundled Code | Time Limit |
|---|---|---|---|---|---|---|---|
| E0781 | 0–20 | 10.10 | RO | RO | DR | 1 | Medical necessity |
| E0791 | 0–20 | 6.24 | RO | RO | DR | 1 | Medical necessity |
Accessibility
Canes, Crutches, and Walkers
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| A4635 | 0–999 | 1.92 | — | 2 | — | 2 per year |
| A4636 | 0–999 | 1.77 | — | 2 | — | 2 per year |
| A4637 | 0–999 | 1.30 | — | 4 | — | 4 per year |
| E0100 | 0–999 | 16.65 | — | 1 | — | 1 per year |
| E0105 | 0–999 | 39.04 | — | 1 | — | 1 per 3 years |
| E0110 | 0–999 | 63.71 | — | 1 | — | 1 per 2 years |
| E0111 | 0–999 | 39.68 | — | 1 | — | 1 per 2 years |
| E0112 | 0–999 | 22.90 | — | 1 | — | 1 per 2 years |
| E0113 | 0–999 | 11.45 | — | 1 | — | 1 per 2 years |
| E0114 | 0–999 | 26.02 | — | 1 | — | 1 per 2 years |
| E0116 | 0–999 | 13.02 | — | 1 | — | 1 per 2 years |
| E0130 | 0–999 | 57.24 | — | 1 | — | 1 per 3 years |
| E0135 | 0–999 | 57.24 | — | 1 | — | 1 per 3 years |
| E0141 | 0–999 | 87.43 | — | 1 | — | 1 per 3 years |
| E0143 | 0–999 | 92.54 | — | 1 | — | 1 per 3 years |
| E0147 | 0–999 | 472.04 | — | 1 | — | 1 per 3 years |
| E0148 | 0–999 | 104.34 | — | 1 | — | 1 per 3 years |
| E0149 | 0–999 | 183.29 | — | 1 | — | 1 per 3 years |
| E0153 | 0–999 | 36.95 | — | 2 | — | 2 per 3 years |
| E0154 | 0–999 | 43.20 | — | 2 | — | 2 per 3 years |
| E0155 | 0–999 | 29.73 | — | 1 | — | 1 per 3 years |
| E0156 | 0–999 | 18.39 | — | 1 | — | 1 per 3 years |
| E0157 | 0–999 | 42.67 | — | 1 | — | 1 per 3 years |
| E0158 | 0–999 | 18.22 | — | 4 | — | 4 per 3 years |
| E0159 | 0–999 | 14.64 | — | 1 | — | 2 per 2 years |
Hospital Beds and Related Equipment
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E0250 | 0–999 | 853.46 | 85.35 | 1 | PA | 1 per 8 years |
| E0255 | 0–999 | 915.91 | 91.59 | 1 | PA | 1 per 8 years |
| E0260 | 0–20 | 1,150.10 | — | 1 | — | 1 per 8 years |
| E0265 | 0–20 | 1,441.52 | — | 1 | — | 1 per 8 years |
| E0271 | 0–999 | 130.10 | — | 1 | — | 1 per 4 years |
| E0272 | 0–999 | 130.10 | — | 1 | — | 1 per 4 years |
| E0303 | 0–999 | 2,590.33 | 259.03 | 1 | PA | 1 per 8 years |
| E0305 | 0–20 | 113.45 | — | 1 | — | 1 per 8 years |
| E0310 | 0–20 | 113.45 | — | 1 | — | 1 per 8 years |
| E0315 | 0–20 | 88.47 | — | 1 | — | 1 per 8 years |
| E0316 | 0–20 | 3,755.50 | — | 1 | PA | 1 per 5 years |
| E0370 | 0–20 | 21.37 | — | 1 | — | 2 per 2 years |
Patient Lifts and Transfer Equipment
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E0621 | 0–999 | 62.45 | — | 1 | — | 1 per 4 years |
| E0630 | 0–999 | 713.01 | 71.30 | 1 | PA | 1 per 8 years |
| E0635 | 0–999 | 713.01 | 71.30 | 1 | PA | 1 per 8 years |
| E0705 | 0–999 | 43.72 | — | 1 | — | 3 per lifetime |
Traction Equipment
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E0840 | 0–20 | 67.65 | — | 1 | — | 1 per lifetime |
| E0850 | 0–20 | 79.10 | — | 1 | — | 1 per lifetime |
| E0860 | 0–999 | 26.55 | — | 1 | — | 1 per lifetime |
| E0870 | 0–20 | 67.65 | — | 1 | — | 1 per lifetime |
| E0880 | 0–20 | 75.98 | — | 1 | — | 1 per lifetime |
| E0890 | 0–20 | 47.88 | — | 1 | — | 1 per lifetime |
| E0900 | 0–20 | 83.26 | — | 1 | — | 1 per lifetime |
Respiratory and Airway Equipment
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E0910 | 0–999 | 161.38 | 16.14 | 1 | — | 1 per 8 years |
| E0920 | 0–20 | 379.95 | 37.99 | 1 | — | 1 per lifetime |
| E0930 | 0–20 | 379.95 | 37.99 | 1 | — | 1 per lifetime |
| E0935 | 0–20 | RO | RO | DR | — | 21 days per medical event |
| E0940 | 0–999 | 286.28 | 28.63 | 1 | — | 1 per 8 years |
| E0942 | 0–20 | 16.65 | — | 1 | — | 1 per medical event |
| E0944 | 0–20 | 13.02 | — | 1 | — | 1 per medical event |
| E0945 | 0–20 | 16.14 | — | 1 | — | 1 per medical event |
| E0947 | 0–20 | 233.70 | 23.37 | 1 | — | 1 per medical event |
| E0948 | 0–20 | 224.79 | 22.48 | 1 | — | 1 per medical event |
Wheelchair Accessories and Positioning Components
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E0950 | 0–999 | 72.34 | — | 1 | — | 2 per 4 years |
| E0951 | 0–999 | 20.41 | — | 2 | — | 2 per year |
| E0952 | 0–999 | 15.43 | — | 2 | — | 2 per year |
| E0955 | 0–999 | 173.55 | — | 1 | PA | 1 per 3 years |
| E0956 | 0–999 | 84.62 | — | 6 | PA | 6 per 3 years |
| E0957 | 0–999 | 118.39 | — | 1 | PA | 1 per 3 years |
| E0958 | 0–999 | 332.42 | — | 1 | — | 1 per 4 years |
| E0959 | 0–999 | 61.54 | — | 2 | — | 2 per 5 years |
| E0960 | 0–999 | 84.90 | — | 1 | PA | 1 per 3 years |
| E0961 | 0–999 | 41.42 | — | 2 | — | 2 per 4 years |
| E0966 | 0–999 | 57.32 | — | 1 | — | 1 per 5 years |
| E0967 | 0–999 | 57.54 | — | 2 | — | 2 per 4 years |
| E0969 | 0–999 | 133.79 | — | 1 | — | 2 per 4 years |
| E0971 | 0–999 | 51.65 | — | 2 | — | 2 per 4 years |
| E0973 | 0–999 | 80.01 | — | 2 | — | 2 per 4 years |
| E0974 | 0–999 | 109.12 | — | 1 | — | 2 per 4 years |
| E0978 | 0–999 | 31.81 | — | 1 | — | 1 per medical event |
| E0980 | 0–999 | 24.01 | — | 1 | — | 2 per 4 years |
| E0981 | 0–999 | 41.32 | — | 1 | — | 2 per 4 years |
| E0982 | 0–999 | 47.59 | — | 1 | — | 1 per 5 years |
| E0983 | 0–999 | 2,387.47 | — | 1 | PA | 1 per 5 years |
| E0984 | 0–999 | 1,564.32 | — | 1 | PA | 1 per 5 years |
| E0986 | 0–999 | 5,219.33 | — | 1 | PA | 1 per 5 years |
| E0990 | 0–999 | 96.15 | — | 2 | — | 2 per 4 years |
| E0992 | 0–999 | 74.53 | — | 1 | — | 1 per 5 years |
| E0994 | 0–999 | 15.05 | — | 2 | — | 2 per 4 years |
| E0995 | 0–999 | 21.16 | — | 2 | — | 2 per 4 years |
| E1015 | 0–999 | 98.46 | — | 2 | PA | 2 per 3 years |
| E1016 | 0–999 | 112.71 | — | 2 | PA | 2 per 3 years |
| E1020 | 0–999 | 208.93 | — | 1 | PA | 1 per 4 years |
| E1028 | 0–999 | 177.39 | — | 6 | PA | 6 per 5 years |
| E1029 | 0–999 | 317.21 | — | 1 | PA | 1 per 4 years |
| E1030 | 0–20 | 1,000.26 | — | 1 | PA | 1 per 4 years |
| E1031 | 0–999 | 366.64 | 36.66 | 1 | — | 1 per 5 years |
Power Wheelchairs and Mobility Equipment
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E1050 | 0–999 | 739.30 | 73.93 | 1 | — | 1 per 5 years |
| E1060 | 0–999 | 915.27 | 91.53 | 1 | — | 1 per 5 years |
| E1070 | 0–999 | 795.20 | 79.52 | 1 | — | 1 per 5 years |
| E1083 | 0–999 | 571.69 | 57.17 | 1 | — | 1 per 5 years |
| E1084 | 0–20 | 712.26 | 71.23 | 1 | — | 1 per 5 years |
| E1085 | 0–999 | 525.66 | 52.57 | 1 | — | 1 per 5 years |
| E1087 | 0–999 | 918.49 | 91.85 | 1 | — | 1 per 5 years |
| E1088 | 0–999 | 1,095.21 | 109.52 | 1 | — | 1 per 5 years |
| E1092 | 0–999 | 932.97 | 93.30 | 1 | — | 1 per 5 years |
| E1093 | 0–999 | 932.97 | 93.30 | 1 | — | 1 per 5 years |
| E1100 | 0–999 | 753.78 | 75.38 | 1 | — | 1 per 5 years |
| E1110 | 0–999 | 738.01 | 73.80 | 1 | — | 1 per 5 years |
| E1150 | 0–999 | 592.30 | 59.23 | 1 | — | 1 per 5 years |
| E1160 | 0–999 | 457.63 | 45.76 | 1 | — | 1 per 5 years |
| E1170 | 0–999 | 648.41 | 64.84 | 1 | — | 1 per 5 years |
| E1171 | 0–999 | 582.00 | 58.20 | 1 | — | 1 per 5 years |
| E1172 | 0–999 | 711.08 | 71.11 | 1 | — | 1 per 5 years |
| E1180 | 0–999 | 735.65 | 73.56 | 1 | — | 1 per 5 years |
| E1190 | 0–999 | 849.92 | 84.99 | 1 | — | 1 per 5 years |
| E1195 | 0–999 | 912.05 | 91.21 | 1 | — | 1 per 5 years |
| E1200 | 0–999 | 631.68 | 63.17 | 1 | — | 1 per 5 years |
| E1221 | 0–999 | 344.86 | 34.49 | 1 | — | 1 per 5 years |
| E1222 | 0–999 | 492.08 | 49.21 | 1 | — | 1 per 5 years |
| E1223 | 0–999 | 537.36 | 53.74 | 1 | — | 1 per 5 years |
| E1224 | 0–999 | 589.18 | 58.92 | 1 | — | 1 per 5 years |
| E1225 | 0–999 | 328.12 | 32.81 | 1 | — | 1 per 5 years |
| E1226 | 0–999 | 379.73 | — | 1 | — | 1 per 5 years |
| E1227 | 0–999 | 237.03 | — | 1 | — | 1 per 5 years |
| E1228 | 0–999 | 20.35 | — | 1 | — | 1 per 5 years |
| E1231 | 0–999 | 2,031.05 | — | 1 | PA | 1 per 5 years |
| E1232 | 0–999 | 1,835.61 | — | 1 | PA | 1 per 5 years |
| E1233 | 0–999 | 1,901.98 | — | 1 | PA | 1 per 5 years |
| E1234 | 0–999 | 1,655.81 | — | 1 | PA | 1 per 5 years |
| E1235 | 0–999 | 1,594.41 | — | 1 | PA | 1 per 5 years |
| E1236 | 0–999 | 1,406.68 | — | 1 | PA | 1 per 5 years |
| E1237 | 0–999 | 1,418.98 | — | 1 | PA | 1 per 5 years |
| E1238 | 0–999 | 1,479.50 | — | 1 | PA | 1 per 5 years |
| E1240 | 0–999 | 747.88 | 74.79 | 1 | — | 1 per 5 years |
| E1270 | 0–999 | 573.20 | 57.32 | 1 | — | 1 per 5 years |
| E1280 | 0–999 | 953.04 | 95.30 | 1 | — | 1 per 5 years |
| E1295 | 0–999 | 881.90 | 88.19 | 1 | — | 1 per 5 years |
| E1296 | 0–999 | 419.96 | — | 1 | — | 1 per 5 years |
| E1297 | 0–999 | 89.35 | — | 1 | — | 1 per 5 years |
| E1298 | 0–999 | 321.14 | — | 1 | — | 1 per 5 years |
Durable Medical Equipment Accessories and Supplies
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E2205 | 0–999 | 28.04 | — | 1 | — | 2 per 4 years |
| E2206 | 0–999 | 33.31 | — | 2 | — | 2 per 4 years |
| E2207 | 0–999 | 37.21 | — | 1 | — | 1 per 5 years |
| E2208 | 0–999 | 101.96 | — | 1 | — | 1 per 5 years |
| E2209 | 0–999 | 92.36 | — | 2 | — | 2 per 4 years |
| E2210 | 0–999 | 5.62 | — | 12 | — | 12 per 4 years |
| E2211 | 0–999 | 35.11 | — | 2 | — | 2 per 2 years |
| E2212 | 0–999 | 5.04 | — | 2 | — | 2 per 2 years |
| E2213 | 0–999 | 26.10 | — | 2 | — | 2 per 2 years |
| E2214 | 0–999 | 26.27 | — | 2 | — | 2 per 2 years |
| E2215 | 0–999 | 8.24 | — | 2 | — | 2 per 2 years |
| E2217 | 0–999 | 29.12 | — | 2 | — | 2 per 2 years |
| E2219 | 0–999 | 30.53 | — | 2 | — | 2 per 2 years |
| E2220 | 0–999 | 24.48 | — | 2 | — | 2 per 2 years |
| E2221 | 0–999 | 21.93 | — | 2 | — | 2 per 2 years |
| E2224 | 0–999 | 84.17 | — | 2 | — | 2 per 2 years |
Wheelchair and Mobility Equipment Components
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E2322 | 0–999 | 1,210.64 | — | 1 | PA | 1 per 5 years |
| E2323 | 0–999 | 59.36 | — | 1 | — | 1 per 5 years |
| E2324 | 0–999 | 37.61 | — | 1 | — | 1 per 5 years |
| E2325 | 0–999 | 1,156.11 | — | 1 | PA | 1 per 5 years |
| E2326 | 0–999 | 297.98 | — | 1 | — | 1 per 5 years |
| E2327 | 0–999 | 2,242.46 | — | 1 | PA | 1 per 5 years |
| E2328 | 0–999 | 4,253.64 | — | 1 | PA | 1 per 5 years |
| E2329 | 0–999 | 1,516.04 | — | 1 | PA | 1 per 5 years |
| E2330 | 0–999 | 2,937.52 | — | 1 | PA | 1 per 5 years |
Wheelchair Seating and Positioning Components
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E2360 | 0–999 | 91.99 | — | 2 | — | 4 per 3 years |
| E2361 | 0–999 | 114.19 | — | 2 | — | 4 per 3 years |
| E2362 | 0–999 | 75.39 | — | 2 | — | 4 per 3 years |
| E2363 | 0–999 | 152.30 | — | 2 | — | 4 per 3 years |
| E2364 | 0–999 | 91.98 | — | 2 | — | 4 per 3 years |
| E2365 | 0–999 | 91.84 | — | 2 | — | 4 per 3 years |
| E2366 | 0–999 | 215.84 | — | 1 | — | 1 per 5 years |
| E2367 | 0–999 | 343.12 | — | 1 | — | 1 per lifetime |
| E2368 | 0–999 | 443.42 | — | 2 | PA | 2 per 5 years |
| E2369 | 0–999 | 386.23 | — | 2 | PA | 2 per 5 years |
| E2370 | 0–999 | 689.16 | — | 2 | PA | 2 per 5 years |
| E2373 | 0–999 | 880.63 | — | 1 | PA | 1 per 5 years |
| E2374 | 0–999 | 458.41 | — | 1 | PA | 1 per 5 years |
| E2381 | 0–999 | 62.37 | — | 2 | — | 2 per 4 years |
| E2382 | 0–999 | 17.01 | — | 2 | — | 2 per 4 years |
| E2383 | 0–999 | 124.36 | — | 2 | — | 2 per 4 years |
| E2384 | 0–999 | 40.53 | — | 2 | — | 2 per 4 years |
| E2385 | 0–999 | 40.53 | — | 2 | — | 2 per 4 years |
| E2386 | 0–999 | 62.37 | — | 2 | — | 2 per 4 years |
| E2387 | 0–999 | 66.25 | — | 2 | — | 2 per 4 years |
| E2388 | 0–999 | 62.37 | — | 2 | — | 2 per 4 years |
| E2389 | 0–999 | 66.25 | — | 2 | — | 2 per 4 years |
| E2390 | 0–999 | 62.37 | — | 2 | — | 2 per 4 years |
| E2391 | 0–999 | 66.25 | — | 2 | — | 2 per 4 years |
| E2394 | 0–999 | 65.88 | — | 2 | — | 2 per 4 years |
| E2395 | 0–999 | 32.69 | — | 2 | — | 2 per 4 years |
| E2396 | 0–999 | 48.29 | — | 2 | — | 2 per 4 years |
Respiratory and Therapeutic Equipment
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| E2601 | 0–999 | 76.10 | — | 1 | PA | 1 per 3 years |
| E2602 | 0–999 | 138.95 | — | 1 | PA | 1 per 3 years |
| E2603 | 0–999 | 200.04 | — | 1 | PA | 1 per 3 years |
| E2604 | 0–999 | 271.04 | — | 1 | PA | 1 per 3 years |
| E2605 | 0–999 | 276.14 | — | 1 | PA | 1 per 3 years |
| E2606 | 0–999 | 374.32 | — | 1 | PA | 1 per 3 years |
| E2607 | 0–999 | 253.74 | — | 1 | PA | 1 per 3 years |
| E2608 | 0–999 | 303.87 | — | 1 | PA | 1 per 3 years |
| E2611 | 0–999 | 268.12 | — | 1 | PA | 1 per 3 years |
| E2612 | 0–999 | 362.71 | — | 1 | PA | 1 per 3 years |
| E2613 | 0–999 | 337.38 | — | 1 | PA | 1 per 3 years |
| E2614 | 0–999 | 466.91 | — | 1 | PA | 1 per 3 years |
| E2615 | 0–999 | 388.27 | — | 1 | PA | 1 per 3 years |
| E2616 | 0–999 | 522.40 | — | 1 | PA | 1 per 3 years |
| E2619 | 0–999 | 52.63 | — | 1 | — | 1 per 3 years |
| E2620 | 0–999 | 470.15 | — | 1 | PA | 1 per 3 years |
| E2621 | 0–999 | 493.38 | — | 1 | PA | 1 per 3 years |
Manual Wheelchairs and Accessories
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| K0001 | 0–999 | 380.16 | 38.02 | 1 | — | 1 per 5 years |
| K0002 | 0–999 | 569.44 | 56.94 | 1 | — | 1 per 5 years |
| K0003 | 0–999 | 623.52 | 62.35 | 1 | — | 1 per 5 years |
| K0004 | 0–999 | 930.08 | 93.01 | 1 | — | 1 per 5 years |
| K0005 | 0–999 | 1,513.68 | — | 1 | — | 1 per 5 years |
| K0006 | 0–999 | 872.78 | 87.28 | 1 | — | 1 per 5 years |
| K0007 | 0–999 | 1,356.16 | 135.62 | 1 | — | 1 per 5 years |
| K0008 | 0–999 | MP | — | 1 | PA | 1 per 5 years |
| K0009 | 0–999 | MP | — | 1 | PA | 1 per 5 years |
| K0010 | 0–999 | 2,964.70 | 296.47 | 1 | PA | 1 per 5 years |
| K0012 | 0–999 | 2,435.07 | 243.51 | 1 | PA | 1 per 5 years |
| K0013 | 0–999 | MP | — | 1 | PA | 1 per 5 years |
| K0014 | 0–999 | MP | — | 1 | PA | 1 per 5 years |
| K0015 | 0–999 | 148.77 | — | 2 | — | 2 per 5 years |
| K0017 | 0–999 | 41.85 | — | 2 | — | 2 per 5 years |
| K0018 | 0–999 | 23.37 | — | 2 | — | 2 per 5 years |
| K0019 | 0–999 | 13.38 | — | 2 | — | 2 per 5 years |
| K0020 | 0–999 | 38.04 | — | 1 | — | 2 per 4 years |
| K0037 | 0–999 | 39.43 | — | 2 | — | 2 per 4 years |
| K0038 | 0–999 | 19.86 | — | 2 | — | 2 per 4 years |
| K0039 | 0–999 | 44.11 | — | 2 | — | 2 per 4 years |
| K0040 | 0–999 | 61.14 | — | 2 | — | 2 per 2 years |
| K0041 | 0–999 | 43.33 | — | 2 | — | 2 per 2 years |
| K0042 | 0–999 | 29.82 | — | 2 | — | 2 per 2 years |
| K0043 | 0–999 | 15.99 | — | 2 | — | 2 per 2 years |
| K0044 | 0–999 | 13.92 | — | 2 | — | 2 per 2 years |
| K0045 | 0–999 | 46.14 | — | 2 | — | 2 per 2 years |
| K0046 | 0–999 | 15.99 | — | 2 | — | 2 per 4 years |
| K0047 | 0–999 | 62.62 | — | 2 | — | 2 per 4 years |
| K0050 | 0–999 | 26.61 | — | 2 | — | 2 per 4 years |
| K0051 | 0–999 | 43.07 | — | 2 | — | 2 per 4 years |
| K0052 | 0–999 | 75.69 | — | 2 | — | 2 per 4 years |
| K0053 | 0–999 | 83.52 | — | 2 | — | 2 per 4 years |
| K0056 | 0–999 | 77.95 | — | 1 | — | 1 per 4 years |
| K0065 | 0–999 | 36.41 | — | 2 | — | 1 per 4 years |
| K0069 | 0–999 | 81.81 | — | 2 | — | 1 per 4 years |
| K0070 | 0–999 | 149.97 | — | 2 | — | 1 per 4 years |
| K0071 | 0–999 | 89.45 | — | 2 | — | 1 per 4 years |
| K0072 | 0–999 | 53.84 | — | 2 | — | 1 per 4 years |
| K0073 | 0–999 | 27.40 | — | 2 | — | 1 per 4 years |
| K0077 | 0–999 | 48.18 | — | 2 | — | 1 per 4 years |
Wheelchair Cushions and Positioning Accessories
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| K0098 | 0–999 | 21.62 | — | 1 | — | 2 per 4 years |
| K0105 | 0–999 | 81.41 | — | 2 | — | 1 per 5 years |
| K0108 | 0–999 | MP | — | 1 | PA | Medical necessity |
| K0195 | 0–999 | 161.59 | 16.16 | 1 | — | 2 per 4 years |
Power Mobility Devices and Scooters
| Code | Age | Maximum Fee | Rental Fee | Rental Units | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|
| K0800 | 0–999 | 1,027.29 | 102.73 | 1 | PA | 1 per 5 years |
| K0801 | 0–999 | 1,656.28 | 165.63 | 1 | PA | 1 per 5 years |
| K0802 | 0–999 | 1,874.42 | 187.44 | 1 | PA | 1 per 5 years |
| K0822 | 0–999 | 3,969.78 | 396.98 | 1 | PA | 1 per 5 years |
| K0823 | 0–999 | 3,969.78 | 396.98 | 1 | PA | 1 per 5 years |
| K0824 | 0–999 | 5,772.63 | 577.26 | 1 | PA | 1 per 5 years |
| K0825 | 0–999 | 5,284.85 | 528.48 | 1 | PA | 1 per 5 years |
| K0826 | 0–999 | 7,473.45 | 747.34 | 1 | PA | 1 per 5 years |
| K0827 | 0–999 | 6,354.63 | 635.46 | 1 | PA | 1 per 5 years |
| K0900 | 0–999 | MP | — | 1 | PA | Per medical event |
Respiratory
Respiratory Supplies and Tracheostomy Equipment
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| A4605 | 0–999 | 2.31 | — | — | 7 | — | — | 372 per year |
| A4608 | 0–999 | 50.07 | — | — | 5 | — | — | 5 per month |
| A4611 | 0–999 | 119.69 | — | — | 1 | — | — | Medical necessity |
| A4612 | 0–999 | 44.24 | — | — | 1 | — | — | Medical necessity |
| A4613 | 0–999 | 100.96 | — | — | 1 | — | — | Medical necessity |
| A4614 | 0–999 | 19.46 | — | — | 1 | — | — | 1 per year |
| A4616 | 0–999 | 0.23 | — | — | 25 | — | — | 300 per year |
| A4618 | 0–999 | 6.19 | — | — | 1 | — | — | Medical necessity |
| A4623 | 0–999 | 6.71 | — | — | 5 | — | — | 60 per year |
| A4624 | 0–999 | 2.31 | — | — | 250 | — | — | 3000 per year |
| A4625 | 0–999 | 7.09 | — | — | 14 | — | — | 14 per medical event |
| A4626 | 0–999 | 1.57 | — | — | 1 | — | — | 12 per year |
| A4627 | 0–999 | 29.51 | — | — | 1 | — | — | 1 per year |
| A4629 | 0–999 | 3.69 | — | — | 31 | — | — | 31 per month |
| A4481 | 0–999 | 0.30 | — | — | 31 | — | — | 31 per month |
Suction Equipment and Related Supplies
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| A7000 | 0–999 | 7.45 | — | — | 1 | — | — | 4 per year |
| A7001 | 0–999 | 23.02 | — | — | 1 | — | — | 1 per 2 years |
| A7002 | 0–999 | 2.66 | — | — | 1 | — | — | 12 per year |
| A7003 | 0–999 | 4.16 | — | — | 3 | — | — | 36 per year |
| A7004 | 0–999 | 1.24 | — | — | 3 | — | — | 36 per year |
| A7005 | 0–999 | 21.45 | — | — | 1 | — | — | 2 per year |
| A7006 | 0–999 | 7.77 | — | — | 3 | — | — | 36 per year |
| A7007 | 0–999 | 4.16 | — | — | 3 | — | — | 36 per year |
| A7008 | 0–999 | 7.65 | — | — | 3 | — | — | 36 per year |
| A7009 | 0–999 | 31.96 | — | — | 1 | — | — | 1 per year |
| A7010 | 0–999 | 16.42 | — | — | 1 | — | — | 12 per year |
| A7012 | 0–999 | 2.94 | — | — | 1 | — | — | 12 per year |
| A7013 | 0–999 | 0.57 | — | — | 31 | — | — | 372 per year |
| A7014 | 0–999 | 3.54 | — | — | 1 | — | — | 12 per year |
| A7015 | 0–999 | 1.53 | — | — | 1 | — | — | 12 per year |
| A7016 | 0–999 | 5.33 | — | — | 1 | — | — | 12 per year |
| A7017 | 0–999 | 109.75 | — | — | 1 | — | — | 1 per year |
| A7020 | 0–999 | 19.89 | — | — | 1 | — | — | 1 per month |
Tracheostomy Supplies and Accessories
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| A7501 | 0–999 | 85.99 | — | — | 1 | — | — | 1 per month |
| A7502 | 0–999 | 40.87 | — | — | 1 | — | — | 1 per month |
| A7503 | 0–999 | 9.28 | — | — | 1 | — | — | 4 per year |
| A7504 | 0–999 | 0.55 | — | — | 31 | — | — | 372 per year |
| A7505 | 0–999 | 3.83 | — | — | 1 | — | — | 12 per year |
| A7506 | 0–999 | 0.28 | — | — | 31 | — | — | 31 per month |
| A7507 | 0–999 | 2.04 | — | — | 1 | — | — | 4 per year |
| A7508 | 0–999 | 2.35 | — | — | 31 | — | — | 31 per month |
| A7520 | 0–999 | 56.20 | — | — | 1 | — | — | Medical necessity |
| A7521 | 0–999 | 56.20 | — | — | 1 | — | — | Medical necessity |
| A7522 | 0–999 | 56.20 | — | — | 1 | — | — | Medical necessity |
| A7525 | 0–999 | 1.27 | — | — | 4 | — | — | 4 per month |
| A7526 | 0–999 | 1.27 | — | — | 14 | — | — | 14 per month |
Oxygen Equipment and Oxygen Supplies
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E0424 | 0–999 | RO | RO | 228.98 | 1 | — | — | 1 per month |
| E0431 | 0–999 | RO | RO | 41.34 | 1 | — | — | 1 per month |
| E0434 | 0–999 | RO | RO | 41.34 | 1 | — | — | 1 per month |
| E0439 | 0–999 | RO | RO | 228.98 | 1 | — | — | 1 per month |
| E0441 | 0–999 | RO | RO | 135.31 | 1 | — | — | 1 per month |
| E0442 | 0–999 | RO | RO | 135.31 | 1 | — | — | 1 per month |
| E0443 | 0–999 | RO | RO | 20.94 | 1 | — | — | 1 per month |
| E0444 | 0–999 | RO | RO | 20.94 | 1 | — | — | 1 per month |
| E0445 | 0–20 | RO | RO | 101.94 | 1 | — | — | Medical necessity |
Respiratory Support and Airway Clearance Equipment
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E0457 | 0–999 | RO | RO | 39.55 | 1 | — | — | Medical necessity |
| E0459 | 0–999 | 365.36 | — | 36.54 | 1 | — | — | Medical necessity |
| E0465 | 0–999 | RO | RO | 811.83 | 1 | BC | — | Medical necessity |
| E0466 | 0–999 | RO | RO | 811.83 | 1 | BC | — | Medical necessity |
| E0468 | 0–999 | 835.15 | — | 83.52 | 1 | — | — | Medical necessity |
| E0470 | 0–999 | RO | RO | 190.73 | 1 | BC | — | 1 per month |
| E0471 | 0–999 | RO | RO | 446.92 | 1 | BC | — | 1 per month |
| E0472 | 0–999 | RO | RO | 446.92 | 1 | BC | — | 1 per month |
| E0480 | 0–999 | 400.77 | — | 40.08 | 1 | — | — | 1 per 4 years |
| E0482 | 0–999 | 5,674.02 | — | — | 1 | — | PA | Medical necessity |
| E0483 | 0–999 | 11,455.62 | — | — | 1 | — | PA | Medical necessity |
| E0485 | 0–999 | MP | — | — | 1 | — | PA | 1 per year |
Humidifiers, Nebulizers, and Respiratory Therapy Equipment
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E0500 | 0–999 | RO | RO | 95.24 | 1 | BC | — | Medical necessity |
| E0550 | 0–999 | RO | RO | 52.04 | 1 | — | — | Medical necessity |
| E0555 | 0–999 | 33.83 | — | — | 1 | — | — | 1 per 2 years |
| E0560 | 0–999 | RO | RO | 15.61 | 1 | — | — | Medical necessity |
| E0561 | 0–999 | RO | RO | 9.38 | 1 | — | — | 1 per month |
| E0562 | 0–999 | RO | RO | 9.38 | 1 | — | — | 1 per month |
| E0565 | 0–999 | RO | RO | 31.22 | 1 | — | — | Medical necessity |
| E0570 | 0–999 | 114.49 | — | — | 1 | — | — | 1 per 2 years |
| E0572 | 0–999 | RO | RO | 28.80 | 1 | — | — | 1 per month |
| E0574 | 0–999 | RO | RO | 30.43 | 1 | — | — | 1 per month |
| E0585 | 0–999 | 161.38 | — | 16.14 | 1 | — | — | 1 per 2 years |
Suction Machines and Positive Airway Pressure Equipment
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E0600 | 0–999 | 326.08 | — | 32.61 | 1 | — | — | 1 per 2 years |
| E0601 | 0–999 | RO | RO | 85.87 | 1 | BC | — | Medical necessity |
| E0605 | 0–999 | 20.30 | — | — | 1 | — | — | 1 per 4 years |
| E0606 | 0–999 | 171.79 | — | 17.18 | 1 | — | — | 1 per 8 years |
Respiratory Monitoring and Related Equipment
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E0618 | 0–20 | RO | RO | 6.60 | DR | 1 | BC | Medical necessity |
| E0619 | 0–20 | RO | RO | 6.60 | DR | 1 | BC | Medical necessity |
Oxygen Concentrators and Portable Oxygen Equipment
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E1390 | 0–999 | RO | RO | 182.93 | 1 | — | — | 1 per month |
| E1392 | 0–999 | RO | RO | 27.52 | 1 | — | — | 1 per month |
Respiratory Medication Delivery and Related Supplies
| Code | Age | Updated Fee | Rental Only | Rental Fee | Rental Units | Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| Q4074 | 0–999 | 26.70 | — | — | 5 | — | — | 155 per month |
Orthotic & Specialized Equipment
Orthotic / Medical Equipment
| Code | Age | Maximum Fee | Rental Only | Rental Fee | Rental Units | Manual Pricing / Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| A6530 | 0–999 | $33.31 | 2 | 8 stockings per year | ||||
| A6531 | 0–999 | $37.14 | 2 | 8 stockings per year | ||||
| A6532 | 0–999 | $65.41 | 2 | 8 stockings per year | ||||
| A6533 | 0–999 | $43.71 | 2 | 8 stockings per year | ||||
| A6534 | 0–999 | $43.71 | 2 | 8 stockings per year | ||||
| A6535 | 0–999 | $43.71 | 2 | 8 stockings per year | ||||
| A6536 | 0–999 | $119.69 | 2 | Per year | ||||
| A6537 | 0–999 | $119.69 | 2 | Per year | ||||
| A6538 | 0–999 | $119.69 | 2 | Per year | ||||
| A6539 | 0–999 | $119.69 | 2 | Per year | ||||
| A6540 | 0–999 | $119.69 | 2 | Per year | ||||
| A6541 | 0–999 | $119.69 | 2 | Per year | ||||
| A8000 | 0–999 | $92.83 | 1 | 1 per year | ||||
| A8001 | 0–999 | $92.83 | 1 | 1 per year | ||||
| A8002 | 0–999 | $265.41 | 1 | Medical necessity | ||||
| A8003 | 0–999 | $265.41 | 1 | Medical necessity | ||||
| E0202 | 0–20 | $45.80 | RO | RO | 1 | DR | 1 per medical event (up to 5 days) | |
| E0205 | 0–20 | $41.63 | 1 | 1 per lifetime | ||||
| E0603 | 0–999 | $133.05 | 1 | PA | 1 per 5 years | |||
| E0604 | 0–999 | $62.31 | RO | RO | BC | PA | 3 months max | |
| E0650 | 0–20 | $520.41 | $52.04 | 1 | 1 per 8 years | |||
| E0651 | 0–20 | $1,010.66 | $101.07 | 1 | 1 per 8 years | |||
| E0652 | 0–20 | $3,959.26 | $395.93 | 1 | 1 per 8 years | |||
| E0655 | 0–20 | $79.10 | 1 | 2 per year | ||||
| E0660 | 0–20 | $72.86 | 1 | 2 per year | ||||
| E0665 | 0–20 | $72.86 | 1 | 2 per year | ||||
| E0666 | 0–20 | $108.77 | 1 | 2 per year | ||||
| E0667 | 0–20 | $424.65 | 1 | 2 per year | ||||
| E0668 | 0–20 | $424.65 | 1 | 2 per year | ||||
| E0744 | 0–20 | $869.13 | $86.91 | 1 | Medical necessity | |||
| E0745 | 0–20 | $770.20 | $77.02 | 1 | Medical necessity | |||
| E0747 | 0–999 | $265.41 | RO | RO | 1 | Maximum 6 months rental | ||
| E1399 | 0–999 | MP | 1 | MP | PA | Medical necessity | ||
| E1902 | 0–999 | MP | 1 | MP | PA | 1 per 5 years |
Specialized Equipment
| Code | Age | Maximum Fee | Rental Only | Rental Fee | Rental Units | Manual Pricing / Bundled Code | Prior Authorization | Time Limit |
|---|---|---|---|---|---|---|---|---|
| E2000 | 0–999 | $24.46 | 1 | 1 per 2 years | ||||
| E2500 | 0–999 | $360.56 | 1 | PA | 1 per 5 years | |||
| E2502 | 0–999 | $1,102.55 | 1 | PA | 1 per 5 years | |||
| E2504 | 0–999 | $1,454.42 | 1 | PA | 1 per 5 years | |||
| E2506 | 0–999 | $2,132.62 | 1 | PA | 1 per 5 years | |||
| E2508 | 0–999 | $3,297.74 | 1 | PA | 1 per 5 years | |||
| E2510 | 0–999 | $6,240.51 | 1 | PA | 1 per 5 years | |||
| E2511 | 0–999 | MP | 1 | MP | PA | 1 per 5 years | ||
| E2512 | 0–999 | MP | 1 | MP | PA | 1 per 5 years | ||
| E2599 | 0–999 | MP | 1 | MP | PA | 1 per 5 years | ||
| K0739 | 0–999 | $10.73 | 16 | $160.00 per year | ||||
| S1040 | 0–20 | $3,219.00 | 1 | PA | Medical necessity | |||
| V5336 | 0–999 | MP | 1 | MP | PA | Medical necessity |
Orthotic and Prosthetic Devices Fee Schedule
Medical/Surgical Supplies
| Code | Age | Orthopedic Specialty | Maximum Fee / Marker | Remaining Schedule Values (as supplied) |
|---|---|---|---|---|
| A4565 | 0-20 | 5.73 | 1 1 PER MEDICAL EVENT | |
| A4570 | 0-20 | 11.45 | 1 1 PER MEDICAL EVENT |
Therapeutic Footwear & Inserts
| Code | Age | Orthopedic Specialty | Maximum Fee / Marker | Remaining Schedule Values (as supplied) |
|---|---|---|---|---|
| A5500 | 0-999 | 54.08 | 2 2 PER MEDICAL EVENT | |
| A5501 | 0-999 | 162.24 | 2 2 PER MEDICAL EVENT | |
| A5503 | 0-999 | 27.47 | 2 2 PER FOOT PER YEAR | |
| A5504 | 0-999 | 27.47 | 2 2 PER FOOT PER YEAR | |
| A5505 | 0-999 | 27.47 | 2 2 PER FOOT PER YEAR | |
| A5506 | 0-999 | 27.47 | 2 2 PER FOOT PER YEAR | |
| A5507 | 0-999 | 28.79 | 2 2 PER FOOT PER YEAR | |
| A5512 | 0-999 | 20.78 | 2 2 PER FOOT PER YEAR | |
| A5513 | 0-999 | 31.02 | 2 2 PER FOOT PER YEAR |
Durable Medical Equipment (DME)
| Code | Age | Orthopedic Specialty | Maximum Fee / Marker | Remaining Schedule Values (as supplied) |
|---|---|---|---|---|
| E1800 | 0-20 | 78.87 | 2 2 PER 2 YEARS | |
| E1801 | 0-999 | 78.87 | 1 2 PER 2 YEARS | |
| E1805 | 0-999 | 81.01 | 2 2 PER 2 YEARS | |
| E1806 | 0-999 | 78.87 | 1 2 PER 2 YEARS | |
| E1810 | 0-999 | 78.87 | 1 2 PER 2 YEARS | |
| E1811 | 0-999 | 78.87 | 1 2 PER 2 YEARS | |
| E1815 | 0-20 | 81.01 | 2 2 PER 2 YEARS | |
| E1816 | 0-999 | 78.87 | 1 2 PER 2 YEARS | |
| E1818 | 0-999 | 78.87 | 1 2 PER 2 YEARS | |
| E1820 | 0-20 | 6.5 | 8 8 PER YEAR | |
| E1821 | 0-999 | 6.5 | 8 8 PER YEAR | |
| E1825 | 0-20 | 81.01 | 2 2 PER 2 YEARS | |
| E1830 | 0-20 | 81.01 | 2 2 PER 2 YEARS | |
| E1840 | 0-999 | 78.87 | 2 2 PER 2 YEARS |
Orthotics, Prosthetics & Related Devices
| Code | Age | Orthopedic Specialty | Maximum Fee / Marker | Remaining Schedule Values (as supplied) |
|---|---|---|---|---|
| L0120 | 0-999 | OS | 13.02 | 1 2 PER MEDICAL EVENT |
| L0130 | 0-999 | 52.04 | 1 1 PER MEDICAL EVENT | |
| L0140 | 0-999 | 41.63 | 1 1 PER YEAR | |
| L0150 | 0-999 | 57.24 | 1 1 PER MEDICAL EVENT | |
| L0160 | 0-999 | 93.67 | 1 1 PER MEDICAL EVENT | |
| L0170 | 0-999 | 374.4 | 1 1 PER MEDICAL EVENT | |
| L0172 | 0-999 | 46.32 | 1 2 PER MEDICAL EVENT | |
| L0174 | 0-999 | 56.2 | 1 1 PER YEAR | |
| L0180 | 0-999 | 193.59 | 1 1 PER MEDICAL EVENT | |
| L0190 | 0-999 | 301.83 | 1 1 PER MEDICAL EVENT | |
| L0200 | 0-999 | 212.33 | 1 1 PER MEDICAL EVENT | |
| L0220 | 0-999 | 62.45 | 1 1 PER YEAR | |
| L0450 | 0-999 | 130.65 | 1 1 PER MEDICAL EVENT | |
| L0452 | 0-999 | 244.14 | 1 1 PER MEDICAL EVENT | |
| L0454 | 0-999 | 236.17 | 1 1 PER MEDICAL EVENT | |
| L0455 | 0-999 | 187.9 | 1 1 PER MEDICAL EVENT | |
| L0456 | 0-999 | 236.17 | 1 1 PER MEDICAL EVENT | |
| L0457 | 0-999 | 187.89 | 1 1 PER MEDICAL EVENT | |
| L0458 | 0-999 | 586.18 | 1 1 PER MEDICAL EVENT | |
| L0460 | 0-999 | 586.18 | 1 1 PER MEDICAL EVENT | |
| L0462 | 0-999 | 586.18 | 1 1 PER MEDICAL EVENT | |
| L0464 | 0-999 | 586.18 | 1 1 PER MEDICAL EVENT | |
| L0466 | 0-999 | 265.57 | 1 1 PER MEDICAL EVENT | |
| L0467 | 0-999 | 213.85 | 1 1 PER MEDICAL EVENT | |
| L0468 | 0-999 | 332.95 | 1 1 PER MEDICAL EVENT | |
| L0470 | 0-999 | 474.04 | 1 1 PER MEDICAL EVENT | |
| L0472 | 0-999 | 297.54 | 1 1 PER MEDICAL EVENT | |
| L0480 | 0-999 | 920.1 | 1 1 PER MEDICAL EVENT | |
| L0482 | 0-999 | 1054.77 | 1 1 PER MEDICAL EVENT | |
| L0484 | 0-999 | 1229.38 | 1 1 PER MEDICAL EVENT | |
| L0486 | 0-999 | 1218.31 | 1 1 PER MEDICAL EVENT | |
| L0488 | 0-999 | 244.14 | 1 1 PER MEDICAL EVENT | |
| L0490 | 0-999 | 788.18 | 1 1 PER MEDICAL EVENT | |
| L0491 | 0-999 | 533.59 | 1 1 PER 2 YEARS | |
| L0621 | 0-999 | 77.44 | 1 1 PER 2 YEARS | |
| L0622 | 0-999 | 209.99 | 1 1 PER 2 YEARS | |
| L0623 | 0-999 | 36.48 | 1 1 PER 2 YEARS | |
| L0624 | 0-999 | 259.32 | 1 1 PER 2 YEARS | |
| L0625 | 0-999 | 47.86 | 1 1 PER 2 YEARS | |
| L0626 | 0-999 | 67.71 | 1 1 PER 2 YEARS | |
| L0627 | 0-999 | 357.01 | 1 1 PER 2 YEARS | |
| L0628 | 0-999 | 72.85 | 1 1 PER 2 YEARS | |
| L0629 | 0-999 | 186.3 | 1 MEDICAL NECESSITY | |
| L0630 | 0-999 | 140.64 | 1 2 PER LIFETIME | |
| L0631 | 0-999 | 891.58 | 1 2 PER LIFETIME | |
| L0641 | 0-999 | 53.86 | 1 1 PER 2 YEARS | |
| L0642 | 0-999 | OS | 284.08 | 1 1 PER 2 YEARS |
| L0648 | 0-999 | 709.46 | 1 2 PER LIFETIME | |
| L0700 | 0-999 | 1509.17 | 1 1 PER MEDICAL EVENT | |
| L0710 | 0-999 | 1665.3 | 1 1 PER MEDICAL EVENT | |
| L0810 | 0-999 | 1665.3 | 1 1 PER MEDICAL EVENT | |
| L0820 | 0-999 | 1248.97 | 1 1 PER MEDICAL EVENT | |
| L0830 | 0-999 | 1639.28 | 1 1 PER MEDICAL EVENT | |
| L0859 | 0-999 | 983.97 | 2 2 EVERY 2 YEARS | |
| L0970 | 0-999 | 54.65 | 1 1 PER 2 YEARS | |
| L0972 | 0-999 | 52.04 | 1 1 PER 2 YEARS | |
| L0974 | 0-999 | 119.69 | 1 1 PER 2 YEARS | |
| L0976 | 0-999 | 120.73 | 1 1 PER 2 YEARS | |
| L0978 | 0-999 | 72.86 | 1 1 PER 2 YEARS | |
| L0980 | 0-999 | 4.16 | 1 2 PER YEAR | |
| L0984 | 0-999 | 36.31 | 2 2 PER YEAR | |
| L0999 | 0-999 | MP | 1 MP PA MEDICAL NECESSITY | |
| L1000 | 0-999 | 1005.42 | 1 1 PER YEAR | |
| L1005 | 0-999 | 64.38 | 1 1 PER 2 YEARS | |
| L1010 | 0-999 | 36.43 | 1 1 PER YEAR | |
| L1020 | 0-999 | 64.02 | 2 2 PER YEAR | |
| L1025 | 0-999 | 84.31 | 1 1 PER YEAR | |
| L1030 | 0-999 | 63.49 | 2 2 PER YEAR | |
| L1040 | 0-999 | 72.86 | 2 2 PER YEAR | |
| L1050 | 0-999 | 42.67 | 1 1 PER YEAR | |
| L1060 | 0-999 | 48.92 | 2 2 PER YEAR | |
| L1070 | 0-999 | 36.43 | 2 2 PER YEAR | |
| L1080 | 0-999 | 46.84 | 2 2 PER YEAR | |
| L1085 | 0-999 | 71.82 | 1 1 PER YEAR | |
| L1090 | 0-999 | 46.84 | 2 2 PER YEAR | |
| L1100 | 0-999 | 78.06 | 1 1 PER YEAR | |
| L1110 | 0-999 | 130.1 | 1 1 PER YEAR | |
| L1120 | 0-999 | 22.9 | 6 6 PER YEAR | |
| L1200 | 0-999 | 728.57 | 1 1 PER YEAR | |
| L1210 | 0-999 | 48.92 | 2 2 PER YEAR | |
| L1220 | 0-999 | 48.92 | 1 1 PER YEAR | |
| L1230 | 0-999 | 286.22 | 1 1 PER 2 YEARS | |
| L1240 | 0-999 | 52.04 | 2 2 PER YEAR | |
| L1250 | 0-999 | 32.27 | 2 2 PER YEAR | |
| L1260 | 0-999 | 62.45 | 2 2 PER YEAR | |
| L1270 | 0-999 | 54.12 | 2 2 PER YEAR | |
| L1280 | 0-999 | 49.96 | 2 2 PER YEAR | |
| L1290 | 0-999 | 46.84 | 2 2 PER YEAR | |
| L1300 | 0-999 | 780.61 | 1 1 PER YEAR | |
| L1310 | 0-999 | 832.65 | 1 1 PER MEDICAL EVENT | |
| L1499 | 0-999 | MP | 1 MP PA MEDICAL NECESSITY | |
| L1600 | 0-999 | 57.24 | 1 1 PER LIFETIME | |
| L1620 | 0-999 | OS | 46.84 | 1 1 PER 5 YEARS |
| L1630 | 0-999 | 57.24 | 1 1 PER LIFETIME | |
| L1640 | 0-999 | 124.9 | 1 1 PER 5 YEARS | |
| L1650 | 0-999 | 124.9 | 1 1 PER LIFETIME | |
| L1652 | 0-999 | 198.14 | 1 1 PER MEDICAL EVENT | |
| L1660 | 0-999 | OS | 31.22 | 1 1 PER 5 YEARS |
| L1680 | 0-999 | 494.38 | 1 1 PER MEDICAL EVENT | |
| L1685 | 0-999 | 879.48 | 1 1 PER MEDICAL EVENT | |
| L1686 | 0-999 | 608.87 | 1 1 PER MEDICAL EVENT | |
| L1690 | 0-999 | 1256.29 | 2 2 PER MEDICAL EVENT | |
| L1700 | 0-999 | 970.03 | 1 1 PER MEDICAL EVENT | |
| L1710 | 0-999 | 598.47 | 1 1 PER MEDICAL EVENT | |
| L1720 | 0-999 | 895.1 | 1 1 PER MEDICAL EVENT | |
| L1730 | 0-999 | 598.47 | 1 1 PER MEDICAL EVENT | |
| L1755 | 0-999 | 785.81 | 1 1 PER MEDICAL EVENT | |
| L1810 | 0-999 | OS | 84.83 | 2 2 PER YEAR |
| L1812 | 0-999 | OS | 63.4 | 2 2 PER YEAR |
| L1820 | 0-999 | OS | 62.45 | 2 2 PER YEAR |
| L1830 | 0-999 | OS | 52.04 | 2 2 PER YEAR |
| L1832 | 0-999 | OS | 600.15 | 2 2 PER 2 YEARS |
| L1833 | 0-999 | OS | 461.15 | 2 2 PER 2 YEARS |
| L1834 | 0-999 | 676.53 | 2 2 PER YEAR | |
| L1836 | 0-999 | OS | 74.17 | 2 2 PER YEAR |
| L1840 | 0-999 | 624.49 | 2 2 PER YEAR | |
| L1843 | 0-999 | OS | 347.35 | 2 2 PER 2 YEARS |
| L1844 | 0-999 | 614.08 | 2 2 PER 2 YEARS | |
| L1845 | 0-999 | OS | 614.08 | 2 2 PER 2 YEARS |
| L1846 | 0-999 | 619.28 | 2 2 PER YEAR | |
| L1847 | 0-999 | OS | 373.67 | 2 2 PER MEDICAL EVENT |
| L1850 | 0-999 | OS | 144.67 | 2 2 PER 2 YEARS |
| L1851 | 0-999 | 286.52 | 2 2 PER 2 YEARS | |
| L1852 | 0-999 | OS | 476.14 | 2 2 PER 2 YEARS |
| L1860 | 0-999 | 520.41 | 2 2 PER 2 YEARS | |
| L1900 | 0-999 | 202.96 | 2 2 PER 2 YEARS | |
| L1902 | 0-999 | OS | 42.16 | 2 2 PER YEAR |
| L1904 | 0-999 | 237.83 | 2 2 PER YEAR | |
| L1906 | 0-999 | OS | 90.04 | 2 2 PER MEDICAL EVENT |
| L1910 | 0-999 | OS | 147.8 | 2 2 PER 2 YEARS |
| L1920 | 0-999 | 135.31 | 2 2 PER YEAR | |
| L1930 | 0-999 | OS | 84.83 | 2 2 PER YEAR |
| L1932 | 0-999 | 832.61 | 2 2 PER YEAR | |
| L1940 | 0-999 | 281.02 | 2 2 PER YEAR | |
| L1945 | 0-999 | 676.53 | 2 2 PER YEAR | |
| L1950 | 0-999 | 231.06 | 2 2 PER YEAR | |
| L1951 | 0-999 | 806.1 | 2 2 PER YEAR | |
| L1960 | 0-999 | 269.57 | 2 2 PER YEAR | |
| L1970 | 0-999 | 390.3 | 2 2 PER YEAR | |
| L1980 | 0-999 | 130.1 | 2 2 PER 2 YEARS | |
| L1990 | 0-999 | 239.39 | 2 2 PER 2 YEARS | |
| L2000 | 0-999 | 302.88 | 2 2 PER 2 YEARS | |
| L2010 | 0-999 | 255 | 2 2 PER 2 YEARS | |
| L2020 | 0-999 | 495.43 | 2 2 PER YEAR | |
| L2030 | 0-999 | 317.45 | 2 2 PER 2 YEARS | |
| L2034 | 0-999 | OS | 1326.23 | 1 2 PER 2 YEARS |
| L2036 | 0-999 | 1124.07 | 2 2 PER YEAR | |
| L2037 | 0-999 | 1144.89 | 2 2 PER 2 YEARS | |
| L2038 | 0-999 | 624.49 | 2 2 PER YEAR | |
| L2040 | 0-999 | 104.08 | 1 1 PER YEAR | |
| L2050 | 0-999 | 249.79 | 1 1 PER YEAR | |
| L2060 | 0-999 | 312.24 | 1 1 PER YEAR | |
| L2070 | 0-999 | 64.53 | 1 1 PER YEAR | |
| L2080 | 0-999 | 202.96 | 1 1 PER YEAR | |
| L2090 | 0-999 | 281.97 | 2 2 PER 2 YEARS | |
| L2106 | 0-999 | 245.63 | 2 2 PER MEDICAL EVENT | |
| L2108 | 0-999 | 642.18 | 2 2 PER MEDICAL EVENT | |
| L2112 | 0-999 | OS | 355.96 | 2 2 PER MEDICAL EVENT |
| L2114 | 0-999 | OS | 499.59 | 2 2 PER MEDICAL EVENT |
| L2116 | 0-999 | OS | 499.59 | 2 2 PER MEDICAL EVENT |
| L2126 | 0-999 | 833.17 | 2 2 PER MEDICAL EVENT | |
| L2128 | 0-999 | 1047.58 | 2 2 PER MEDICAL EVENT | |
| L2132 | 0-999 | OS | 523.53 | 2 2 PER MEDICAL EVENT |
| L2134 | 0-999 | 523.53 | 2 2 PER MEDICAL EVENT | |
| L2136 | 0-999 | 714 | 2 2 PER MEDICAL EVENT | |
| L2180 | 0-999 | 46.84 | 2 2 PER MEDICAL EVENT | |
| L2182 | 0-999 | 44.16 | 2 2 PER MEDICAL EVENT | |
| L2184 | 0-999 | 79.52 | 2 2 PER MEDICAL EVENT | |
| L2186 | 0-999 | 46.84 | 2 2 PER MEDICAL EVENT | |
| L2188 | 0-999 | 309.12 | 2 2 PER MEDICAL EVENT | |
| L2190 | 0-999 | 51.53 | 2 2 PER MEDICAL EVENT | |
| L2192 | 0-999 | 161.33 | 1 1 PER MEDICAL EVENT | |
| L2200 | 0-999 | 22.44 | 4 2 PER INDIVIDUAL ORTHOSIS | |
| L2210 | 0-999 | 46.84 | 4 2 PER INDIVIDUAL ORTHOSIS | |
| L2220 | 0-999 | 60.37 | 4 2 PER INDIVIDUAL ORTHOSIS | |
| L2230 | 0-999 | 33.31 | 2 2 PER ORTHOSIS | |
| L2240 | 0-999 | 33.31 | 2 2 PER ORTHOSIS | |
| L2250 | 0-999 | 192.55 | 2 2 PER ORTHOSIS | |
| L2260 | 0-999 | 72.86 | 2 2 PER ORTHOSIS | |
| L2265 | 0-999 | 20.82 | 2 2 PER ORTHOSIS | |
| L2270 | 0-999 | 33.31 | 4 1 PER ORTHOSIS | |
| L2275 | 0-999 | 78.17 | 4 Only 2 PER ORTHOSIS | |
| L2280 | 0-999 | 260.2 | 2 2 PER 3 YEARS | |
| L2300 | 0-999 | 78.06 | 1 1 PER 2 YEARS | |
| L2310 | 0-999 | 46.84 | 1 1 PER 2 YEARS | |
| L2320 | 0-999 | 72.86 | 2 2 PER ORTHOSIS | |
| L2330 | 0-999 | 173.82 | 2 2 PER ORTHOSIS | |
| L2335 | 0-999 | 118.65 | 2 2 PER ORTHOSIS | |
| L2340 | 0-999 | 311.2 | 2 2 PER ORTHOSIS | |
| L2350 | 0-999 | 390.3 | 4 2 PER INDIVIDUAL ORTHOSIS | |
| L2360 | 0-999 | 31.22 | 4 4 PER YEAR | |
| L2370 | 0-999 | 70.78 | 4 2 PER INDIVIDUAL ORTHOSIS | |
| L2375 | 0-999 | 46.84 | 4 4 PER ORTHOSIS | |
| L2380 | 0-999 | 46.84 | 4 4 PER ORTHOSIS | |
| L2385 | 0-999 | 23.42 | 4 4 PER ORTHOSIS | |
| L2390 | 0-999 | 45.28 | 4 4 PER ORTHOSIS | |
| L2395 | 0-999 | 78.82 | 4 4 PER ORTHOSIS | |
| L2397 | 0-999 | 70.11 | 2 4 PER ORTHOSIS | |
| L2405 | 0-999 | 22.9 | 4 4 PER ORTHOSIS | |
| L2415 | 0-999 | 152.48 | 4 4 PER ORTHOSIS | |
| L2425 | 0-999 | 112.41 | 4 4 PER ORTHOSIS | |
| L2430 | 0-999 | 62.56 | 4 2 PER ORTHOSIS | |
| L2492 | 0-999 | 20.82 | 4 2 PER ORTHOSIS | |
| L2500 | 0-999 | 106.16 | 2 1 PER INDIVIDUAL ORTHOSIS | |
| L2510 | 0-999 | 359.08 | 2 1 PER ORTHOSIS | |
| L2520 | 0-999 | 187.35 | 2 1 PER ORTHOSIS | |
| L2525 | 0-999 | 676.53 | 2 1 PER ORTHOSIS | |
| L2526 | 0-999 | 468.36 | 2 1 PER ORTHOSIS | |
| L2530 | 0-999 | 93.67 | 2 1 PER ORTHOSIS | |
| L2540 | 0-999 | 173.82 | 2 1 PER ORTHOSIS | |
| L2550 | 0-999 | 121.77 | 2 1 PER ORTHOSIS | |
| L2570 | 0-999 | 98.88 | 2 1 PER ORTHOSIS | |
| L2580 | 0-999 | 381.98 | 1 1 PER 2 YEARS | |
| L2600 | 0-999 | 88.47 | 2 2 PER ORTHOSIS | |
| L2610 | 0-999 | 114.75 | 2 2 PER ORTHOSIS | |
| L2620 | 0-999 | 126.5 | 2 1 PER ORTHOSIS | |
| L2622 | 0-999 | 90.04 | 2 2 PER ORTHOSIS | |
| L2624 | 0-999 | 285.71 | 2 1 PER ORTHOSIS | |
| L2627 | 0-999 | 714 | 1 1 PER 2 YEARS | |
| L2628 | 0-999 | 1092.85 | 1 1 PER YEAR | |
| L2630 | 0-999 | 88.47 | 1 1 PER ORTHOSIS | |
| L2640 | 0-999 | 130.1 | 1 1 PER YEAR | |
| L2650 | 0-999 | 52.04 | 1 2 PER YEAR | |
| L2660 | 0-999 | 93.67 | 1 1 PER 2 YEARS | |
| L2670 | 0-999 | 72.86 | 1 1 PER 2 YEARS | |
| L2680 | 0-999 | 62.45 | 2 2 PER YEAR | |
| L2750 | 0-999 | 50 | 2 4 PER ORTHOSIS | |
| L2755 | 0-999 | 83.16 | 2 1 PER ORTHOSIS | |
| L2760 | 0-999 | 29.14 | 8 4 PER ORTHOSIS | |
| L2768 | 0-999 | 16.1 | 2 2 PER 2 YEARS | |
| L2780 | 0-999 | 42.98 | 4 4 PER ORTHOSIS | |
| L2785 | 0-999 | 22.9 | 4 2 PER KAFO | |
| L2795 | 0-999 | 38.51 | 2 1 PER KAFO | |
| L2800 | 0-999 | 52.57 | 2 1 PER KAFO | |
| L2810 | 0-999 | 51.53 | 2 2 PER KAFO | |
| L2820 | 0-999 | 32.79 | 2 1 PER KAFO | |
| L2830 | 0-999 | 32.79 | 2 1 PER KAFO | |
| L2840 | 0-999 | 40.34 | 2 2 PER MEDICAL EVENT | |
| L2850 | 0-999 | 31.22 | 2 2 PER MEDICAL EVENT | |
| L2999 | 0-999 | OS | MP | 1 MP PA MEDICAL NECESSITY |
| L3000 | 0-999 | 181.1 | 2 1 PER FOOT PER YEAR | |
| L3001 | 0-999 | 31.22 | 2 2 PER FOOT PER YEAR | |
| L3002 | 0-999 | 83.26 | 2 2 PER FOOT PER YEAR | |
| L3010 | 0-999 | 83.26 | 2 1 PER FOOT PER YEAR | |
| L3020 | 0-999 | 83.26 | 2 1 PER FOOT PER YEAR | |
| L3030 | 0-999 | 78.06 | 2 2 PER FOOT PER YEAR | |
| L3040 | 0-999 | 62.45 | 2 2 PER FOOT PER YEAR | |
| L3050 | 0-999 | 62.45 | 2 2 PER FOOT PER YEAR | |
| L3060 | 0-999 | 83.26 | 2 2 PER FOOT PER YEAR | |
| L3070 | 0-999 | 9.37 | 2 1 PER FOOT PER YEAR | |
| L3080 | 0-999 | 4.69 | 2 1 PER FOOT PER YEAR | |
| L3100 | 0-999 | 26.02 | 2 2 PER YEAR | |
| L3140 | 0-999 | 37.99 | 1 2 PER YEAR | |
| L3150 | 0-999 | 30.18 | 1 2 PER YEAR | |
| L3170 | 0-999 | OS | 16.65 | 2 2 PER FOOT PER YEAR |
| L3201 | 0-20 | 39.04 | 2 3 PAIR PER YEAR | |
| L3202 | 0-20 | 39.04 | 2 3 PAIR PER YEAR | |
| L3203 | 0-20 | 39.04 | 2 3 PAIR PER YEAR | |
| L3204 | 0-20 | 37.47 | 2 3 PAIR PER YEAR | |
| L3206 | 0-20 | 44.75 | 2 3 PAIR PER YEAR | |
| L3207 | 0-20 | 56.2 | 2 3 PAIR PER YEAR | |
| L3208 | 0-20 | OS | 18.73 | 2 2 PER FOOT PER YEAR |
| L3209 | 0-20 | OS | 18.73 | 2 2 PER FOOT PER YEAR |
| L3211 | 0-20 | OS | 20.82 | 2 2 PER FOOT PER YEAR |
| L3215 | 0-999 | 85.35 | 2 2 PER FOOT PER YEAR | |
| L3216 | 0-999 | 85.35 | 2 2 PER FOOT PER YEAR | |
| L3217 | 0-999 | 97.84 | 2 2 PER FOOT PER YEAR | |
| L3219 | 0-999 | 85.35 | 2 2 PER FOOT PER YEAR | |
| L3221 | 0-999 | 74.94 | 2 2 PER FOOT PER YEAR | |
| L3222 | 0-999 | 103.04 | 2 2 PER FOOT PER YEAR | |
| L3230 | 0-999 | 85.35 | 2 2 PER FOOT PER YEAR | |
| L3251 | 0-999 | 229.02 | 2 2 PER FOOT PER YEAR | |
| L3253 | 0-999 | 70.78 | 2 1 PER FOOT PER YEAR | |
| L3254 | 0-999 | 2.14 | 2 6 PER YEAR | |
| L3255 | 0-999 | 3.38 | 2 6 PER YEAR | |
| L3257 | 0-999 | MP | 1 MP PA 3 PER YEAR | |
| L3300 | 0-999 | 19.26 | 3 3 PER YEAR | |
| L3310 | 0-999 | 37.99 | 3 3 PER YEAR | |
| L3320 | 0-999 | 115.01 | 3 3 PER YEAR | |
| L3330 | 0-999 | 313.14 | 3 3 PER YEAR | |
| L3332 | 0-999 | 27.59 | 3 3 PER YEAR | |
| L3334 | 0-999 | 18.22 | 3 3 PER YEAR | |
| L3340 | 0-999 | 51.53 | 2 4 PER YEAR | |
| L3350 | 0-999 | 13.53 | 2 4 PER YEAR | |
| L3360 | 0-999 | 20.82 | 2 4 PER YEAR | |
| L3370 | 0-999 | 15.61 | 2 4 PER YEAR | |
| L3380 | 0-999 | 16.65 | 2 4 PER YEAR | |
| L3390 | 0-999 | 24.46 | 2 4 PER YEAR | |
| L3400 | 0-999 | 26.02 | 2 4 PER YEAR | |
| L3410 | 0-999 | 11.97 | 2 4 PER YEAR | |
| L3420 | 0-999 | 20.3 | 2 4 PER YEAR | |
| L3430 | 0-999 | 21.34 | 2 2 PER YEAR | |
| L3440 | 0-999 | 30.18 | 2 2 PER YEAR | |
| L3450 | 0-999 | 27.59 | 2 2 PER YEAR | |
| L3460 | 0-999 | 9.89 | 2 2 PER YEAR | |
| L3465 | 0-999 | 11.97 | 2 2 PER YEAR | |
| L3470 | 0-999 | 15.61 | 2 2 PER YEAR | |
| L3480 | 0-999 | 10.41 | 2 2 PER FOOT PER YEAR | |
| L3570 | 0-999 | 21.86 | 2 6 PER YEAR | |
| L3580 | 0-999 | 36.15 | 2 2 PER YEAR | |
| L3590 | 0-999 | 29.77 | 2 2 PER YEAR | |
| L3595 | 0-999 | 21.86 | 2 2 PER YEAR | |
| L3600 | 0-999 | 35.39 | 2 3 PER YEAR | |
| L3610 | 0-999 | 55.99 | 2 3 PER YEAR | |
| L3620 | 0-999 | 34.35 | 2 3 PER YEAR | |
| L3630 | 0-999 | 55.99 | 2 3 PER YEAR | |
| L3640 | 0-999 | 24.1 | 1 3 PER YEAR | |
| L3649 | 0-999 | MP | 1 MP PA MEDICAL NECESSITY | |
| L3650 | 0-999 | OS | 29.14 | 2 2 PER MEDICAL EVENT |
| L3660 | 0-999 | OS | 46.32 | 2 2 PER MEDICAL EVENT |
| L3670 | 0-999 | OS | 62.45 | 2 2 PER MEDICAL EVENT |
| L3675 | 0-999 | OS | 103.76 | 1 1 PER 2 YEARS |
| L3677 | 0-999 | OS | 155.05 | 2 2 PER 2 YEARS |
| L3710 | 0-999 | OS | 84.87 | 2 2 PER YEAR |
| L3720 | 0-999 | 242.51 | 2 2 PER YEAR | |
| L3730 | 0-999 | 403.83 | 2 2 PER YEAR | |
| L3740 | 0-999 | 475.65 | 2 2 PER YEAR | |
| L3760 | 0-999 | OS | 288.18 | 2 PER MEDICAL EVENT |
| L3761 | 0-999 | OS | 403.07 | 2 PER MEDICAL EVENT |
| L3762 | 0-999 | OS | 54.4 | 2 2 PER YEAR |
| L3763 | 0-999 | 234.18 | 2 2 PER MEDICAL EVENT | |
| L3764 | 0-999 | 309.12 | 2 2 PER MEDICAL EVENT | |
| L3808 | 0-999 | 186.12 | 2 2 PER MEDICAL EVENT | |
| L3809 | 0-999 | OS | 139.35 | 2 2 PER MEDICAL EVENT |
| L3900 | 0-999 | 952.34 | 2 2 PER YEAR | |
| L3901 | 0-999 | 975.76 | 2 2 PER YEAR | |
| L3904 | 0-999 | 2087.41 | 2 1 PER ORTHOSIS | |
| L3906 | 0-999 | 259.16 | 2 2 PER MEDICAL EVENT | |
| L3908 | 0-999 | OS | 18.73 | 2 4 PER YEAR |
| L3912 | 0-999 | OS | 20.82 | 2 2 PER 2 YEARS |
| L3918 | 0-999 | 63.46 | 2 2 PER 2 YEARS | |
| L3923 | 0-999 | OS | 23.48 | 1 PER MEDICAL EVENT |
| L3924 | 0-999 | OS | 23.48 | 1 PER MEDICAL EVENT |
| L3925 | 0-999 | OS | 35.78 | 2 2 PER YEAR |
| L3929 | 0-999 | OS | 57.02 | 2 2 PER YEAR |
| L3931 | 0-999 | OS | 137.93 | 2 2 PER YEAR |
| L3960 | 0-999 | OS | 317.97 | 2 2 PER MEDICAL EVENT |
| L3962 | 0-999 | OS | 199.84 | 2 2 PER 2 YEARS |
| L3980 | 0-999 | OS | 130.1 | 2 2 PER MEDICAL EVENT |
| L3982 | 0-999 | OS | 234.18 | 2 2 PER MEDICAL EVENT |
| L3984 | 0-999 | OS | 262.28 | 2 2 PER MEDICAL EVENT |
| L3995 | 0-999 | OS | 12.49 | 2 6 PER MEDICAL EVENT |
| L3999 | 0-999 | MP | 2 MP PA MEDICAL NECESSITY | |
| L4000 | 0-999 | 676.53 | 2 2 PER 2 YEARS | |
| L4010 | 0-999 | 187.35 | 2 2 PER LIFETIME | |
| L4020 | 0-999 | 359.08 | 2 2 PER YEAR | |
| L4030 | 0-999 | 187.35 | 2 2 PER YEAR | |
| L4040 | 0-999 | 189.43 | 2 2 PER YEAR | |
| L4045 | 0-999 | 189.95 | 2 2 PER YEAR | |
| L4050 | 0-999 | 171.73 | 2 2 PER YEAR | |
| L4055 | 0-999 | 166.01 | 2 2 PER YEAR | |
| L4060 | 0-999 | 220.65 | 2 2 PER YEAR | |
| L4070 | 0-999 | 93.67 | 4 4 PER YEAR | |
| L4080 | 0-999 | 49.37 | 2 2 PER YEAR | |
| L4090 | 0-999 | 44.2 | 2 2 PER YEAR | |
| L4100 | 0-999 | 39.55 | 2 2 PER YEAR | |
| L4110 | 0-999 | 35.39 | 2 2 PER YEAR | |
| L4130 | 0-999 | 311.2 | 2 2 PER YEAR | |
| L4205 | 0-999 | 10.73 | 16 $160.00 PER YEAR | |
| L4210 | 0-999 | MP | 1 MP PA LIMITED TO $160 PER YEAR | |
| L4350 | 0-999 | OS | 64.53 | 2 2 PER MEDICAL EVENT (One per Leg) |
| L4360 | 0-999 | OS | 198.27 | 2 2 PER MEDICAL EVENT (One per Leg) |
| L4361 | 0-999 | OS | 198.27 | 2 2 PER MEDICAL EVENT (One per Leg) |
| L4370 | 0-999 | OS | 78.06 | 2 2 PER MEDICAL EVENT |
| L4386 | 0-999 | OS | 114.9 | 2 2 PER MEDICAL EVENT (One per Leg) |
| L4387 | 0-999 | OS | 114.9 | 2 2 PER MEDICAL EVENT (One per Leg) |
| L4392 | 0-999 | 14.97 | 1 2 PER YEAR | |
| L4394 | 0-999 | 10.94 | 1 2 PER YEAR | |
| L4396 | 0-999 | 106.87 | 2 2 PER YEAR | |
| L4397 | 0-999 | 106.87 | 2 2 PER YEAR | |
| L4398 | 0-999 | 49.14 | 2 2 PER 2 YEARS | |
| L5000 | 0-999 | 139.47 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5010 | 0-999 | 565.69 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5020 | 0-999 | 565.69 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5050 | 0-999 | 1488.88 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5060 | 0-999 | 1342.64 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5100 | 0-999 | 1477.95 | 2 2 PER PROSTHETIC PER YEAR | |
| L5105 | 0-999 | 1845.36 | 2 2 PER PROSTHETIC PER YEAR | |
| L5150 | 0-999 | 2081.62 | 2 2 PER PROSTHETIC PER YEAR | |
| L5160 | 0-999 | 2185.7 | 2 2 PER PROSTHETIC PER YEAR | |
| L5200 | 0-999 | 1838.07 | 2 2 PER PROSTHETIC PER YEAR | |
| L5210 | 0-999 | 1353.05 | 2 2 PER PROSTHETIC PER YEAR | |
| L5220 | 0-999 | 1353.05 | 2 2 PER PROSTHETIC PER YEAR | |
| L5230 | 0-999 | 1873.46 | 2 2 PER PROSTHETIC PER YEAR | |
| L5250 | 0-999 | 3047.49 | 2 2 PER PROSTHETIC PER YEAR | |
| L5280 | 0-999 | 3226.51 | 2 2 PER PROSTHETIC PER YEAR | |
| L5301 | 0-999 | 1563.41 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5312 | 0-999 | 3175.07 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5321 | 0-999 | 2714.98 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5331 | 0-999 | 3459.44 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5341 | 0-999 | 3601.29 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5400 | 0-999 | 728.57 | 2 1 PER AMPUTATION | |
| L5410 | 0-999 | 218.57 | 2 1 PER AMPUTATION | |
| L5420 | 0-999 | 785.81 | 2 1 PER AMPUTATION | |
| L5430 | 0-999 | 218.57 | 2 1 PER AMPUTATION | |
| L5450 | 0-999 | 244.59 | 2 1 PER AMPUTATION | |
| L5460 | 0-999 | 405.92 | 2 1 PER AMPUTATION | |
| L5530 | 0-999 | 941.93 | 2 1 PER AMPUTATION | |
| L5535 | 0-999 | 780.61 | 2 1 PER AMPUTATION | |
| L5540 | 0-999 | 941.93 | 2 1 PER AMPUTATION | |
| L5560 | 0-999 | 936.73 | 4 2 PER AMPUTATION | |
| L5580 | 0-999 | 1014.79 | 2 1 PER AMPUTATION | |
| L5585 | 0-999 | 861.79 | 2 1 PER AMPUTATION | |
| L5590 | 0-999 | 1145.93 | 2 1 PER AMPUTATION | |
| L5595 | 0-999 | 2227.33 | 2 1 PER AMPUTATION | |
| L5600 | 0-999 | 2477.13 | 2 1 PER AMPUTATION | |
| L5610 | 0-999 | 987.73 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5611 | 0-999 | 988.77 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5613 | 0-999 | 1821.42 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5616 | 0-999 | 520.41 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5617 | 0-999 | 346.58 | 2 2 PER PROSTHETIC PER 3 YEARS | |
| L5618 | 0-999 | 182.14 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5620 | 0-999 | 156.12 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5622 | 0-999 | 182.14 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5624 | 0-999 | 174.86 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5626 | 0-999 | 182.14 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5628 | 0-999 | 182.14 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5629 | 0-999 | 130.1 | 2 1 PER PROSTHESIS | |
| L5630 | 0-999 | 260.2 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5631 | 0-999 | 208.16 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5632 | 0-999 | 128.58 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5634 | 0-999 | 78.06 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5636 | 0-999 | 127.44 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5637 | 0-999 | 130.1 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5638 | 0-999 | 182.14 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5639 | 0-999 | 604.4 | 2 1 PER PROSTHESIS | |
| L5640 | 0-999 | 398.63 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5642 | 0-999 | 398.63 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5643 | 0-999 | 428.3 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5644 | 0-999 | 104.08 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5645 | 0-999 | 142.59 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5646 | 0-999 | 226.9 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5647 | 0-999 | 285.71 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5648 | 0-999 | 226.9 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5649 | 0-999 | 1428.52 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5650 | 0-999 | 104.08 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5651 | 0-999 | 475.65 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5652 | 0-999 | 234.18 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5653 | 0-999 | 260.2 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5654 | 0-999 | 218.57 | 2 2 PER PROSTHETIC PER YEAR | |
| L5655 | 0-999 | 174.86 | 2 2 PER PROSTHETIC PER YEAR | |
| L5656 | 0-999 | 234.18 | 2 2 PER PROSTHETIC PER YEAR | |
| L5658 | 0-999 | 234.18 | 2 2 PER PROSTHETIC PER YEAR | |
| L5661 | 0-999 | 237.3 | 2 2 PER PROSTHETIC PER YEAR | |
| L5665 | 0-999 | 213.37 | 2 2 PER PROSTHETIC PER YEAR | |
| L5666 | 0-999 | 31.22 | 2 2 PER PROSTHETIC PER YEAR | |
| L5668 | 0-999 | 83.26 | 2 2 PER PROSTHETIC PER YEAR | |
| L5670 | 0-999 | 114.49 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5671 | 0-999 | 404.16 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5672 | 0-999 | 99.92 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5673 | 0-999 | 484.17 | 2 1 PER PROSTHESIS | |
| L5676 | 0-999 | 230.02 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5677 | 0-999 | 271.14 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5678 | 0-999 | 10.41 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5679 | 0-999 | 403.47 | 2 2 PER PROSTHETIC PER YEAR | |
| L5680 | 0-999 | 197.75 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5681 | 0-999 | 858.09 | 2 1 PER PROSTHESIS | |
| L5682 | 0-999 | 208.16 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5684 | 0-999 | 15.61 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5685 | 0-999 | 48.92 | 2 6 PER PROSTHETIC PER YEAR | |
| L5686 | 0-999 | 10.41 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5688 | 0-999 | 37.47 | 2 2 PER PROSTHETIC PER YEAR | |
| L5690 | 0-999 | 54.12 | 2 2 PER PROSTHETIC PER YEAR | |
| L5692 | 0-999 | 46.84 | 2 2 PER PROSTHETIC PER YEAR | |
| L5694 | 0-999 | 87.43 | 2 2 PER PROSTHETIC PER YEAR | |
| L5695 | 0-999 | 96.28 | 2 4 PER PROSTHETIC PER YEAR | |
| L5696 | 0-999 | 98.88 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5697 | 0-999 | 52.04 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5698 | 0-999 | 78.06 | 2 2 PER PROSTHETIC PER YEAR | |
| L5699 | 0-999 | 41.63 | 2 2 PER PROSTHETIC PER YEAR | |
| L5700 | 0-999 | 1826.02 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5701 | 0-999 | 2192.92 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5702 | 0-999 | 2774.37 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5704 | 0-999 | 341.6 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5705 | 0-999 | 610.39 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5706 | 0-999 | 598.35 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5707 | 0-999 | 788.84 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5710 | 0-999 | 104.08 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5711 | 0-999 | 94.71 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5712 | 0-999 | 260.2 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5714 | 0-999 | 225.19 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5716 | 0-999 | 260.2 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5718 | 0-999 | 428.3 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5722 | 0-999 | 528.73 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5724 | 0-999 | 698.38 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5726 | 0-999 | 690.06 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5728 | 0-999 | 1149.05 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5780 | 0-999 | 729.66 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5785 | 0-999 | 332.54 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5790 | 0-999 | 567.13 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5795 | 0-999 | 1129.17 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5810 | 0-999 | 94.71 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5811 | 0-999 | 366.93 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5812 | 0-999 | 338.26 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5814 | 0-999 | 2360.6 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5816 | 0-999 | 237.3 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5818 | 0-999 | 427.77 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5822 | 0-999 | 483.98 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5824 | 0-999 | 651.55 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5828 | 0-999 | 1142.81 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5830 | 0-999 | 843.06 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5840 | 0-999 | 2236.04 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5845 | 0-999 | 1143.82 | 2 2 PER PROSTHETIC PER 3 YEARS | |
| L5850 | 0-999 | 46.84 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5855 | 0-999 | 219.09 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5910 | 0-999 | 94.71 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5920 | 0-999 | 189.95 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5940 | 0-999 | 365.32 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5950 | 0-999 | 618.63 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5960 | 0-999 | 1284.36 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5962 | 0-999 | 404.33 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5964 | 0-999 | 596.87 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5966 | 0-999 | 760.54 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5968 | 0-999 | 2365.44 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5970 | 0-999 | 52.04 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5972 | 0-999 | 189.95 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5974 | 0-999 | 72.86 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5975 | 0-999 | 301.77 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5976 | 0-999 | 312.24 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5978 | 0-999 | 145.71 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5979 | 0-999 | 1454.19 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5980 | 0-999 | 2362.97 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5981 | 0-999 | 1908.95 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5982 | 0-999 | 219.61 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5984 | 0-999 | 261.24 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5985 | 0-999 | 174.9 | 2 2 PER PROSTHETIC PER 3 YEARS | |
| L5986 | 0-999 | 218.57 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5987 | 0-999 | 4587.08 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5988 | 0-999 | 1300.35 | 2 2 PER PROSTHETIC PER 4 YEARS | |
| L5990 | 0-999 | 42.33 | 2 2 PER PROSTHETIC PER 2 YEARS | |
| L5999 | 0-999 | MP | 1 MP PA MEDICAL NECESSITY | |
| L6000 | 0-999 | 684.85 | 2 2 PER 4 YEARS | |
| L6010 | 0-999 | 684.85 | 2 2 PER 4 YEARS | |
| L6020 | 0-999 | 684.85 | 2 2 PER 2 YEARS | |
| L6050 | 0-999 | 1087.65 | 2 2 PER 2 YEARS | |
| L6055 | 0-999 | 1328.07 | 2 2 PER 4 YEARS | |
| L6100 | 0-999 | 1083.48 | 2 2 PER 2 YEARS | |
| L6110 | 0-999 | 1134.48 | 2 2 PER 2 YEARS | |
| L6120 | 0-999 | 1321.83 | 2 2 PER 4 YEARS | |
| L6130 | 0-999 | 1321.83 | 2 2 PER 4 YEARS | |
| L6200 | 0-999 | 1524.79 | 2 2 PER 4 YEARS | |
| L6205 | 0-999 | 1761.05 | 2 2 PER 4 YEARS | |
| L6250 | 0-999 | 1529.99 | 2 2 PER 2 YEARS | |
| L6300 | 0-999 | 2029.58 | 2 2 PER 2 YEARS | |
| L6310 | 0-999 | 2029.58 | 2 2 PER 4 YEARS | |
| L6320 | 0-999 | 676.53 | 2 2 PER 4 YEARS | |
| L6350 | 0-999 | 2029.58 | 2 2 PER 2 YEARS | |
| L6360 | 0-999 | 2237.74 | 2 2 PER 4 YEARS | |
| L6370 | 0-999 | 676.53 | 2 2 PER 4 YEARS | |
| L6380 | 0-999 | 778.44 | 2 1 PER ORTHOSIS | |
| L6382 | 0-999 | 1171.15 | 2 1 PER ORTHOSIS | |
| L6384 | 0-999 | 1620.14 | 2 1 PER ORTHOSIS | |
| L6386 | 0-999 | 255.93 | 2 1 PER ORTHOSIS | |
| L6388 | 0-999 | 280.18 | 2 1 PER ORTHOSIS | |
| L6400 | 0-999 | 1353.05 | 2 2 PER 4 YEARS | |
| L6450 | 0-999 | 1951.52 | 2 2 PER 4 YEARS | |
| L6500 | 0-999 | 1951.52 | 2 2 PER 4 YEARS | |
| L6550 | 0-999 | 2029.58 | 2 2 PER 4 YEARS | |
| L6570 | 0-999 | 2237.74 | 2 2 PER 4 YEARS | |
| L6580 | 0-999 | 1064.95 | 2 2 PER 4 YEARS | |
| L6582 | 0-999 | 964.55 | 2 2 PER 4 YEARS | |
| L6584 | 0-999 | 1512.5 | 2 2 PER 4 YEARS | |
| L6586 | 0-999 | 1415.61 | 2 2 PER 4 YEARS | |
| L6588 | 0-999 | 2325.11 | 2 2 PER 4 YEARS | |
| L6590 | 0-999 | 1766.81 | 2 2 PER 4 YEARS | |
| L6600 | 0-999 | 57.24 | 2 2 PER 4 YEARS | |
| L6605 | 0-999 | 57.24 | 2 2 PER 4 YEARS | |
| L6610 | 0-999 | 57.24 | 2 2 PER 4 YEARS | |
| L6615 | 0-999 | 137.39 | 2 2 PER 2 YEARS | |
| L6616 | 0-999 | 46.84 | 2 6 PER 4 YEARS | |
| L6620 | 0-999 | 175.9 | 2 2 PER 2 YEARS | |
| L6624 | 0-999 | 1510.37 | 2 1 PER ORTHOSIS | |
| L6625 | 0-999 | 156.12 | 2 2 PER 4 YEARS | |
| L6628 | 0-999 | 305.31 | 2 2 PER 4 YEARS | |
| L6629 | 0-999 | 93.24 | 2 2 PER 4 YEARS | |
| L6630 | 0-999 | 109.61 | 2 2 PER 2 YEARS | |
| L6632 | 0-999 | 32.79 | 2 12 PER YEAR | |
| L6635 | 0-999 | 81.18 | 2 2 PER 2 YEARS | |
| L6637 | 0-999 | 239.43 | 2 2 PER 4 YEARS | |
| L6640 | 0-999 | 168.1 | 2 2 PER 4 YEARS | |
| L6641 | 0-999 | 56.73 | 2 2 PER 4 YEARS | |
| L6642 | 0-999 | 71.82 | 2 2 PER 4 YEARS | |
| L6645 | 0-999 | 253.44 | 2 2 PER 4 YEARS | |
| L6650 | 0-999 | 267.49 | 2 2 PER 4 YEARS | |
| L6655 | 0-999 | 20.82 | 2 2 PER YEAR | |
| L6660 | 0-999 | 26.02 | 2 2 PER YEAR | |
| L6665 | 0-999 | 22.69 | 2 2 PER YEAR | |
| L6670 | 0-999 | 12.49 | 2 2 PER YEAR | |
| L6672 | 0-999 | 41.63 | 2 2 PER YEAR | |
| L6675 | 0-999 | 33.31 | 2 2 PER YEAR | |
| L6676 | 0-999 | 83.26 | 2 2 PER YEAR | |
| L6680 | 0-999 | 72.86 | 2 2 PER PROSTHESIS | |
| L6682 | 0-999 | 83.26 | 2 2 PER PROSTHESIS | |
| L6684 | 0-999 | 88.47 | 2 2 PER PROSTHESIS | |
| L6686 | 0-999 | 332.54 | 2 2 PER 4 YEARS | |
| L6687 | 0-999 | 285.71 | 2 2 PER 4 YEARS | |
| L6688 | 0-999 | 285.71 | 2 2 PER 4 YEARS | |
| L6689 | 0-999 | 427.77 | 2 2 PER 4 YEARS | |
| L6690 | 0-999 | 427.77 | 2 2 PER 4 YEARS | |
| L6691 | 0-999 | 213.89 | 2 2 PER YEAR | |
| L6692 | 0-999 | 390.3 | 2 2 PER 2 YEARS | |
| L6693 | 0-999 | 1847.98 | 2 2 PER 4 YEARS | |
| L6703 | 0-999 | 290.25 | 2 2 PER 4 YEARS | |
| L6706 | 0-999 | 278.57 | 2 2 PER 4 YEARS | |
| L6707 | 0-999 | 1026.79 | 2 2 PER 4 YEARS | |
| L6708 | 0-999 | 671.25 | 2 2 PER 4 YEARS | |
| L6709 | 0-999 | 967.28 | 2 2 PER 4 YEARS | |
| L6805 | 0-999 | 167.57 | 2 2 PER 4 YEARS | |
| L6810 | 0-999 | 87.43 | 2 2 PER 4 YEARS | |
| L6881 | 0-999 | 536.5 | 2 2 PER 2 YEARS | |
| L6882 | 0-999 | 2503.8 | 1 2 PER 2 YEARS | |
| L6890 | 0-999 | 83.79 | 2 2 PER YEAR | |
| L6900 | 0-999 | 565.16 | 2 2 PER 4 YEARS | |
| L6905 | 0-999 | 565.16 | 2 2 PER 4 YEARS | |
| L6910 | 0-999 | 565.16 | 2 2 PER 4 YEARS | |
| L6915 | 0-999 | 296.63 | 2 2 PER 4 YEARS | |
| L6920 | 0-999 | 2706.11 | 2 2 PER LIFETIME | |
| L6925 | 0-999 | 3434.67 | 2 2 PER LIFETIME | |
| L6930 | 0-999 | 2706.11 | 2 2 PER LIFETIME | |
| L6935 | 0-999 | 3434.67 | 2 2 PER LIFETIME | |
| L6940 | 0-999 | 3887.43 | 2 2 PER LIFETIME | |
| L6945 | 0-999 | 4615.99 | 2 2 PER LIFETIME | |
| L6950 | 0-999 | 4492.14 | 2 2 PER LIFETIME | |
| L6955 | 0-999 | 5220.7 | 2 2 PER LIFETIME | |
| L6960 | 0-999 | 6551.9 | 2 2 PER LIFETIME | |
| L6965 | 0-999 | 5823.33 | 2 2 PER LIFETIME | |
| L6970 | 0-999 | 6551.9 | 2 2 PER LIFETIME | |
| L6975 | 0-999 | 7280.47 | 2 2 PER LIFETIME | |
| L7007 | 0-999 | 2831.17 | 2 2 PER LIFETIME | |
| L7008 | 0-999 | 2331.41 | 2 2 PER LIFETIME | |
| L7009 | 0-999 | 2774.8 | 2 2 PER LIFETIME | |
| L7040 | 0-999 | 1057.46 | 2 2 PER LIFETIME | |
| L7045 | 0-999 | 501.67 | 2 2 PER LIFETIME | |
| L7170 | 0-999 | 3664.69 | 2 2 PER LIFETIME | |
| L7185 | 0-999 | 3664.69 | 2 2 PER LIFETIME | |
| L7186 | 0-999 | 6753.82 | 2 2 PER LIFETIME | |
| L7360 | 0-999 | 85.35 | 2 2 PER 3 YEARS | |
| L7362 | 0-999 | 85.35 | 2 2 PER LIFETIME | |
| L7364 | 0-999 | 130.1 | 2 2 PER 3 YEARS | |
| L7366 | 0-999 | 267.49 | 1 1 PER 3 YEARS | |
| L7499 | 0-999 | MP | 2 MP PA MEDICAL NECESSITY | |
| L7520 | 0-999 | MP | 1 MP PA MEDICAL NECESSITY | |
| L8000 | 0-999 | 28.04 | 2 2 PER YEAR | |
| L8001 | 0-999 | 134.13 | 2 2 PER 2 YEARS | |
| L8002 | 0-999 | 177.05 | 2 2 PER 2 YEARS | |
| L8010 | 0-999 | 39.86 | 6 6 PER YEAR | |
| L8015 | 0-999 | 36.93 | 2 2 PER 4 YEARS | |
| L8020 | 0-999 | 145.31 | 2 2 PER YEAR | |
| L8030 | 0-999 | 157.16 | 2 2 PER 2 YEARS | |
| L8300 | 0-999 | 67.65 | 1 2 PER YEAR | |
| L8310 | 0-999 | 182.14 | 1 2 PER YEAR | |
| L8400 | 0-999 | 6.24 | 6 72 PER PROSTHETIC PER YEAR | |
| L8410 | 0-999 | 6.24 | 6 72 PER PROSTHETIC PER YEAR | |
| L8415 | 0-999 | 9.37 | 6 72 PER PROSTHETIC PER YEAR | |
| L8417 | 0-999 | 47.75 | 2 6 PER PROSTHETIC PER YEAR | |
| L8420 | 0-999 | 13.53 | 6 72 PER PROSTHETIC PER YEAR | |
| L8430 | 0-999 | 14.57 | 6 72 PER PROSTHETIC PER YEAR | |
| L8435 | 0-999 | 13.53 | 6 72 PER PROSTHETIC PER YEAR | |
| L8440 | 0-999 | 31.22 | 2 4 PER PROSTHETIC PER YEAR | |
| L8460 | 0-999 | 46.32 | 2 4 PER PROSTHETIC PER YEAR | |
| L8465 | 0-999 | 37.99 | 2 4 PER PROSTHETIC PER YEAR | |
| L8470 | 0-999 | 2.08 | 6 72 PER PROSTHETIC PER YEAR | |
| L8480 | 0-999 | 2.61 | 6 72 PER PROSTHETIC PER YEAR | |
| L8485 | 0-999 | 7.08 | 2 72 PER PROSTHETIC PER YEAR | |
| L8499 | 0-999 | MP | 1 MP PA MEDICAL NECESSITY | |
| L8500 | 0-999 | 420.62 | 1 1 PER LIFETIME | |
| L8501 | 0-999 | 124.9 | 1 6 PER YEAR | |
| L8507 | 0-999 | 124.9 | 1 1 PER 5 YEARS |
Vision/Ocular Prosthetic Devices
| Code | Age | Orthopedic Specialty | Maximum Fee / Marker | Remaining Schedule Values (as supplied) |
|---|---|---|---|---|
| V2623 | 0-999 | 608.87 | 2 MEDICAL NECESSITY | |
| V2624 | 0-999 | 41.63 | 2 2 PER YEAR | |
| V2625 | 0-999 | 260.2 | 2 1 PER PROSTHESIS | |
| V2626 | 0-999 | 166.53 | 2 1 PER PROSTHESIS | |
| V2627 | 0-999 | 967.95 | 2 MEDICAL NECESSITY | |
| V2628 | 0-999 | 223.77 | 2 MEDICAL NECESSITY |
QIO Wheelchair Pricing and Enteral Nutrition Product Lists
QIO pricing note: The supplied guide states that the wheelchair codes and rates below are used by the Agency’s fee-for-service Quality Improvement Organization (QIO) vendor for pricing purposes only. They are not separately available through the DME program; fee-for-service providers are reimbursed for codes submitted with custom wheelchair and wheelchair repair requests.
Category 1: Wheelchair Components, Accessories, and Power Seating
| Code | Rate |
|---|---|
| E0988 | $265.39 |
| E1006 | $5,130.36 |
| E1007 | $6,946.70 |
| E1008 | $6,947.32 |
| E1010 | $908.97 |
| E1014 | $336.67 |
| E1017 | $131.54 |
| E1086 | $844.02 |
| E1089 | $1,273.76 |
| E1090 | $1,361.53 |
| E1130 | $489.42 |
| E1140 | $682.55 |
| E1161 | $2,181.61 |
| E1250 | $782.54 |
| E1260 | $966.67 |
| E1285 | $1,270.00 |
| E1290 | $1,110.02 |
| E2201 | $344.01 |
| E2202 | $437.02 |
| E2203 | $441.70 |
| E2204 | $749.98 |
| E2216 | $31.37 |
| E2218 | $48.39 |
| E2219 | $43.62 |
| E2225 | $16.04 |
| E2226 | $34.99 |
| E2227 | $1,658.46 |
| E2228 | $863.26 |
| E2231 | $141.70 |
| E2310 | $929.99 |
| E2311 | $1,882.81 |
| E2312 | $1,787.98 |
| E2313 | $283.92 |
| E2321 | $1,262.86 |
| E2340 | $330.42 |
| E2341 | $495.67 |
| E2342 | $413.05 |
| E2343 | $660.89 |
| E2351 | $555.20 |
| E2359 | $154.37 |
| E2371 | $119.79 |
| E2375 | $680.71 |
| E2376 | $1,066.70 |
| E2392 | $42.82 |
Category 2: Wheelchair Seat Cushions
| Code | Rate |
|---|---|
| E2622 | $263.42 |
| E2623 | $335.19 |
| E2624 | $265.58 |
| E2625 | $336.21 |
| E2626 | $572.69 |
| E2627 | $913.84 |
| E2628 | $688.43 |
| E2629 | $871.19 |
| E2630 | $609.22 |
| E2631 | $243.70 |
| E2632 | $154.96 |
| E2633 | $129.02 |
Category 3: Power Wheelchair Battery Accessory
| Code | Rate |
|---|---|
| K0733 | $24.01 |
Category 4: Power-Operated Vehicle Bases
| Code | Rate |
|---|---|
| K0806 | $1,242.83 |
| K0807 | $1,885.86 |
| K0808 | $2,917.83 |
Category 5: Power Wheelchair Bases
| Code | Rate |
|---|---|
| K0813 | $2,012.86 |
| K0814 | $2,576.85 |
| K0815 | $2,933.96 |
| K0816 | $2,809.99 |
| K0820 | $2,150.11 |
| K0821 | $2,760.12 |
| K0828 | $5,764.52 |
| K0829 | $5,293.48 |
| K0835 | $3,385.66 |
| K0836 | $3,511.12 |
| K0837 | $4,040.86 |
| K0838 | $3,614.95 |
| K0839 | $5,231.44 |
| K0840 | $7,925.55 |
| K0841 | $3,603.66 |
| K0842 | $3,603.66 |
| K0843 | $4,338.71 |
| K0848 | $4,409.44 |
| K0849 | $4,239.57 |
| K0850 | $5,114.87 |
| K0851 | $4,917.90 |
| K0852 | $5,909.90 |
| K0853 | $6,070.99 |
| K0854 | $8,042.66 |
| K0855 | $7,597.47 |
| K0856 | $4,733.13 |
| K0857 | $4,827.95 |
| K0858 | $5,872.46 |
| K0859 | $5,600.44 |
| K0860 | $8,389.49 |
| K0861 | $6,106.68 |
| K0862 | $4,740.70 |
| K0863 | $5,872.46 |
| K0864 | $8,389.49 |
Enteral Nutrition Product Listings
Enteral Formula — Manufactured Blenderized Natural-Food Formulas
The source lists the following products under HCPCS code B4149.
| Code | Product Name |
|---|---|
| B4149 | Compleat Pediatric |
| Compleat Pediatric Reduced Calorie | |
| Compleat |
Enteral Formula — Standard Intact-Nutrient Formulas
The source lists the following products under HCPCS code B4150.
| Code | Product Name |
|---|---|
| B4150 | Kate Farms® Pediatric Blended Meals – Banana & Blue |
| Kate Farms® Pediatric Blended Meals – Mango & Straw | |
| Kate Farms® Pediatric Blended Meals – Squash & Carrot | |
| Boost | |
| Boost High Protein | |
| Ensure | |
| Ensure High Protein | |
| Fibersource HN | |
| Isosource | |
| Isosource HN | |
| Jevity 1 Cal | |
| Jevity 1.2 Cal |
B4150SC — Listed Formula Products
The product list preserves the B4150SC code exactly as supplied.
| Code | Product Name |
|---|---|
| B4150SC | Kate Farms® Standard 1.0 Chocolate |
| Kate Farms® Standard 1.0 Plain | |
| Kate Farms® Standard 1.0 Vanilla | |
| Kate Farms® Standard 1.4 Chocolate | |
| Kate Farms® Standard 1.4 Plain | |
| Kate Farms® Standard 1.4 Strawberry | |
| Kate Farms® Standard 1.4 Vanilla |
Enteral Formula — Calorically Dense Formulas
The source lists the following products under HCPCS code B4152.
| Code | Product Name |
|---|---|
| B4152 | Lipistart |
| Nutren 1.0 | |
| Nutren 1.0 Fiber | |
| Nutren Replete | |
| Osmolite | |
| Osmolite 1 Cal | |
| Osmolite 1.2 Cal | |
| Promote | |
| Promote with Fiber | |
| Replete | |
| Replete with Fiber |
B4152SC — Listed Formula Products
The product list preserves the B4152SC code exactly as supplied.
| Code | Product Name |
|---|---|
| B4152SC | Boost Plus |
| Ensure Complete | |
| Ensure Plus | |
| Ensure Plus HN | |
| Isosource 1.5 | |
| Jevity 1.5 | |
| Nutren 1.5 | |
| Nutren 2.0 | |
| Osmolite 1.5 Cal | |
| Resource 2.0 | |
| Resurgex Plus | |
| TwoCal HN |
Enteral Formula — Hydrolyzed-Protein / Peptide Formulas
The source lists the following products under HCPCS code B4153.
| Code | Product Name |
|---|---|
| B4153 | Impact Peptide 1.5 |
| Impact Glutamine | |
| Kate Farms® Peptide 1.0 Plain | |
| Kate Farms® Peptide 1.0 Vanilla | |
| Kate Farms® Peptide 1.5 Plain | |
| Kate Farms® Peptide 1.5 Vanilla | |
| L-Emental | |
| Peptamen | |
| Peptamen 1.5 | |
| Peptamen AF | |
| Peptamen with PreBio1 | |
| Perative |
Enteral Nutrition Products and Codes
| Code | Product Name |
|---|---|
| B4154 | Tolerex |
| Vital 1.0 Cal | |
| Vital 1.5 Cal | |
| Vital AF 1.2 Cal | |
| Vital HN | |
| Vivonex Plus | |
| Vivonex RTF | |
| Vivonex TEN | |
| B4154SC | Glucerna 1.0 |
| Glucerna 1.2 | |
| Glucerna 1.5 | |
| Glytrol | |
| Impact | |
| Impact 1.5 | |
| Impact Advanced Recovery | |
| Impact with Fiber | |
| Kate Farms® Glucose Support 1.2 Vanilla | |
| Kate Farms® Renal Support 1.8 Vanilla | |
| B4155 | KetoCal |
| KetoCal 3.1 | |
| KetoCal 4.1 | |
| KetoVie | |
| Nepro | |
| NovaSource Renal | |
| Nutren Pulmonary | |
| NutriHep | |
| NutriRenal | |
| Oxepa | |
| Pulmocare | |
| Ren/Gen | |
| Renalcal | |
| Resource Diabetic | |
| Suplena | |
| B4155SC | Complex MSD Amino Acid Blend |
| Beneprotein | |
| Duocal | |
| GlutarAde GA-1 Amino Acid Blend | |
| Glycosade | |
| Liquigen | |
| MCT Oil | |
| MCT procal | |
| Microlipid | |
| OS 2 (Milupa OS 2) | |
| PhenylAde Amino Acid Blend MTE | |
| Polycose | |
| ProMod | |
| ProPhree | |
| Proteinex Liquid | |
| ProViMin | |
| Ross Carbohydrate Free | |
| SolCarb | |
| Acerflex 454g | |
| Camino pro- MSUD 140ml | |
| Camino pro- PKU 140ml | |
| Complex Essential MSD 454g | |
| Cyclinex – 2 400g | |
| Glutarex – 2 400g | |
| B4161 | HCY 2 454g |
| Hominex – 2 400g | |
| I – Valex – 2 400g | |
| Ketonex – 2 400g | |
| MSUD 2 (Milupa) 500g | |
| MSUD Maxamum 454g | |
| Periflex Junior 454g | |
| Phenex – 2 400g | |
| PhenylAde Essential 454g | |
| Phenyl-Free 2 454g | |
| Phenyl-Free 2HP 454g | |
| Propimex – 2 400g | |
| Tyrex – 2 400g | |
| WND 2 400g | |
| XLEU Maxamum 454g | |
| XLYS, TRY Maxamum 500g | |
| XMET Maxamum 454g | |
| XP Maxamum 500g | |
| B4161SC | Boost Kid Essentials |
| Boost Kid Essentials 1.5 | |
| Boost Kid Essentials 1.5 with Fiber | |
| B4157 | Kate Farms® Kids Nutrition Chocolate |
| Kate Farms® Kids Nutrition Strawberry | |
| Kate Farms® Kids Nutrition Vanilla | |
| Kate Farms® Pediatric Standard 1.2 Chocolate | |
| Kate Farms® Pediatric Standard 1.2 Vanilla | |
| Kindercal | |
| Kindercal TF | |
| Kindercal TF with Fiber | |
| Kindercal with Fiber | |
| B4157SC | Nutren Junior |
| Nutren Junior with Fiber | |
| PediaSure | |
| PediaSure 1.5 Cal | |
| PediaSure 1.5 Cal with Fiber | |
| PediaSure Enteral | |
| PediaSure Enteral with Fiber | |
| PediaSure with Fiber | |
| B4160 | Alfamino Infant 400g |
| Alfamino Junior 400g | |
| E028 Splash 237mL | |
| EleCare (for infants) 400g | |
| EleCare Junior 400g | |
| Gerber Extensive HA 400g | |
| Homactin AA Plus 250ml | |
| Isovactin AA Plus 250ml | |
| Kate Farms® Pediatric Peptide 1.0 Strawberry | |
| Kate Farms® Pediatric Peptide 1.0 Vanilla | |
| Kate Farms® Pediatric Peptide 1.5 Plain | |
| Kate Farms® Pediatric Peptide 1.5 Vanilla | |
| B4160SC | Neocate 400g |
| Neocate Junior 400g | |
| Neocate Nutra 400g | |
| Nutramigen with Enflora LGG 357g | |
| PediaSure Peptide 1.0 Cal 237mL | |
| PediaSure Peptide 1.5 Cal 237mL | |
| B4162 | Pepdite One+ (Pepdite Junior) 51g |
| Peptamen Junior 1.5 250mL | |
| Peptamen Junior 250mL | |
| Peptamen Junior Fiber 250mL | |
| Peptamen Junior Prebio 250mL | |
| Phenactin AA Plus 250ml | |
| Portagen 454g | |
| Pregestimil 24 454g | |
| Pregestimil 454g | |
| Promactin AA Plus 250ml | |
| Puramino Infant | |
| Puramino Jr Unflavored | |
| Puramino Jr Vanilla | |
| Similac Expert Care Alimentum 454g | |
| Vilactin AA Plus 250mL | |
| Vivonex Pediatric 250mL | |
| B4162SC | 3232A 454g |
| Calcilo XD 375g | |
| Complex JR MSD 400g | |
| Cyclinex – 1 400g | |
| GlutarAde Junior GA-1 400g | |
| Glutarex – 1 400g | |
| Glytactin RTD 250mL | |
| Hominex – 1 400g | |
| I – Valex – 1 400g | |
| Ketonex – 1 400g | |
| Milupa HOM 2 500g | |
| MSUD 1 500g | |
| MSUD Analog 400g | |
| OS 1 500g | |
| Periflex Infant 400g | |
| Phenex – 1 400g | |
| PhenylAde60 454g | |
| Phenyl-Free 1 454g | |
| PKU 1 500g | |
| PKU 2 500g | |
| PKU 3 500g | |
| Propimex – 1 400g | |
| Tylactin RTD 15 250ml | |
| TYR 2 500g | |
| Tyrex – 1 400g | |
| TYROS 1 454g | |
| TYROS 2 454g | |
| UCD 2 450g | |
| XLEU Analog 400g | |
| XLEU Maxamaid 454g | |
| XLYS, XTrp Analog 400g | |
| XLYS, XTrp Maxamaid 454g | |
| XMET Analog 400g | |
| XMET Maxamaid 454g | |
| XMTVI Analog 400g | |
| XMTVI Maxamaid 454g | |
| XPhe, XTyr Analog 400g | |
| XPTM Analog 400g |
Surgically Implantable Devices
The codes and descriptions below are reimbursable only to hospitals and ambulatory surgical centers enrolled in the Fee-for-Service delivery system.
| Code | Modifier | Age | Maximum Fee | Prior Authorization | Limit |
|---|---|---|---|---|---|
| E0783 | 0–999 | $9,991.75 | PA | Medical necessity | |
| E0786 | 0–999 | $9,392.25 | PA | Medical necessity | |
| L8679 | 0–999 | $17,383.00 | Medical necessity | ||
| SC | 0–999 | $8,691.00 | Medical necessity |