*
*

Fee Schedule Category: Prosthetics and Orthotics
Short Description for L1843: KO SINGLE UPRIGHT PRE CST
Long Description for L1843: KNEE ORTHOSIS, SINGLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PATIENT BY AN INDIVIDUAL WITH EXPERTISE

Rural ZIP Code Checker


Beneficiary State of Residence Modifier Modifier Rural Fee Non-Rural Fee Effective From Effective To
AK $1,004.32 10/01/2023 12/31/2023
ND $1,040.29 10/01/2023 12/31/2023
SC $1,034.55 10/01/2023 12/31/2023
IN $1,029.00 10/01/2023 12/31/2023
OK $1,034.47 10/01/2023 12/31/2023
ME $1,004.32 10/01/2023 12/31/2023
MA $1,004.32 10/01/2023 12/31/2023
GA $1,034.55 10/01/2023 12/31/2023
NH $1,004.32 10/01/2023 12/31/2023
LA $1,034.47 10/01/2023 12/31/2023
SD $1,040.29 10/01/2023 12/31/2023
MT $1,040.29 10/01/2023 12/31/2023
CT $1,004.32 10/01/2023 12/31/2023
KS $1,023.95 10/01/2023 12/31/2023
NE $1,023.95 10/01/2023 12/31/2023
DC $1,004.32 10/01/2023 12/31/2023
CA $1,004.32 10/01/2023 12/31/2023
MS $1,034.55 10/01/2023 12/31/2023
MI $1,029.00 10/01/2023 12/31/2023
MO $1,023.95 10/01/2023 12/31/2023
DE $1,004.32 10/01/2023 12/31/2023
MN $1,029.00 10/01/2023 12/31/2023
IL $1,029.00 10/01/2023 12/31/2023
AL $1,034.55 10/01/2023 12/31/2023
KY $1,034.55 10/01/2023 12/31/2023
FL $1,034.55 10/01/2023 12/31/2023
HI $1,004.32 10/01/2023 12/31/2023
VI $1,104.77 10/01/2023 12/31/2023
UT $1,040.29 10/01/2023 12/31/2023
VT $1,004.32 10/01/2023 12/31/2023
TX $1,034.47 10/01/2023 12/31/2023
MD $1,004.32 10/01/2023 12/31/2023
TN $1,034.55 10/01/2023 12/31/2023
AR $1,034.47 10/01/2023 12/31/2023
OR $1,004.32 10/01/2023 12/31/2023
NV $1,004.32 10/01/2023 12/31/2023
PA $1,004.32 10/01/2023 12/31/2023
ID $1,004.32 10/01/2023 12/31/2023
NY $1,004.32 10/01/2023 12/31/2023
IA $1,023.95 10/01/2023 12/31/2023
WA $1,004.32 10/01/2023 12/31/2023
CO $1,040.29 10/01/2023 12/31/2023
PR $1,104.77 10/01/2023 12/31/2023
WI $1,029.00 10/01/2023 12/31/2023
RI $1,004.32 10/01/2023 12/31/2023
VA $1,004.32 10/01/2023 12/31/2023
AZ $1,004.32 10/01/2023 12/31/2023
NJ $1,004.32 10/01/2023 12/31/2023
NM $1,034.47 10/01/2023 12/31/2023
OH $1,029.00 10/01/2023 12/31/2023
WY $1,040.29 10/01/2023 12/31/2023
NC $1,034.55 10/01/2023 12/31/2023
WV $1,004.32 10/01/2023 12/31/2023
Notes:
  1. PDAC provides the CMS quarterly fee schedule amounts directly from the CMS website. If CMS updates the fee schedule within a quarter, DMECS will display the most current fee schedule.
  2. A blank cell in the Rural Fee column designates the Rural Fee is the same as the Non-Rural Fee.
  3. This HCPCS code may be subject to a single payment amount (SPA) under the Medicare DMEPOS Competitive Bidding Program. For information on when the SPA applies, specific rates for the SPA, please check the website for the Competitive Bidding Implementation Contractor (CBIC) at https://www.dmecompetitivebid.com.
  4. This HCPCS code may be subject to an adjusted fee schedule amount in accordance with regulations in CFR 414.210(g). For information on when the adjusted fee schedule applies and specific HCPCS code rates, please check the former CBA ZIP Code File and Former CBA Fee Schedule File on CMS's website at DMEPOS Fee Schedule Files | CMS.