AFO Product DMEPOS By State Fee Schedule 2022
TurboMed XTERN
HCPCS
CEILING
FLOOR
CEILING % CHANGE
FLOOR % CHANGE
XTERN
L1951 - Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment
1055.35
791.51
5.3096%
5.3086%
L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section.
114.22
85.67
5.3107%
5.3104%
Total HCPCS
1169.57
877.18
5.3097%
5.3088%
Tamarack Free Motion
HCPCS
CEILING
FLOOR
CEILING % CHANGE
FLOOR % CHANGE
A200
L1970 - Ankle foot orthosis, plastic with ankle joint, custom fabricated
935.93
701.95
5.3098%
5.3109%
L2275 - Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
164.96
123.72
5.3048%
5.3115%
L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
114.22
85.67
5.3107%
5.3104%
Total HCPCS
1215.11
911.34
5.3092%
5.3110%
Tamarack Free Motion
HCPCS
CEILING
FLOOR
CEILING % CHANGE
FLOOR % CHANGE
A200
L1970 - Ankle foot orthosis, plastic with ankle joint, custom fabricated
935.93
701.95
5.3098%
5.3109%
L2275 - Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
164.96
123.72
5.3048%
5.3115%
L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
114.22
85.67
5.3107%
5.3104%
Total HCPCS
1215.11
911.34
5.3092%
5.3110%
Tamarack Free Motion
HCPCS
CEILING
FLOOR
CEILING % CHANGE
FLOOR % CHANGE
A200
L1970 - Ankle foot orthosis, plastic with ankle joint, custom fabricated
935.93
701.95
5.3098%
5.3109%
L2275 - Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined
164.96
123.72
5.3048%
5.3115%
L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section
114.22
85.67
5.3107%
5.3104%
Total HCPCS
1215.11
911.34
5.3092%
5.3110%