AFO Product DMEPOS By State Fee Schedule 2022

AFO Product DMEPOS By State Fee Schedule 2022

Comparison spreadsheet
2022 spreadsheet
2020 spreadsheet
Comparison spreadsheet
2022 spreadsheet
2020 spreadsheet

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 Calf Lacer

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A200L

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%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

Total HCPCS

1731.58

1298.69

5.3093%

5.3106%

Overlap Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A250

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 Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A300

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%

L2210 - Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

88.41

66.31

5.3001%

5.3041%

L2210 - Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

88.41

66.31

5.3001%

5.3041%

Total HCPCS

1391.93

1043.96

5.3080%

5.3101%

Cabbie

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G50

L1907 - Ankle foot orthosis, plastic or other material, custom fabricated

707.10

530.32

5.3110%

5.3100%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

Total HCPCS

1223.57

917.67

5.3104%

5.3098%

Short

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G100

L1940 - Ankle foot orthosis, plastic or other material, custom fabricated

650.48

487.86

5.3102%

5.3102%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

Total HCPCS

1281.17

960.88

5.3100%

5.3100%

Standard

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G120

L1940 - Ankle foot orthosis, plastic or other material, custom fabricated

650.48

487.86

5.3102%

5.3102%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

Total HCPCS

1281.17

960.88

5.3100%

5.3100%

Tall

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G140

L1940 - Ankle foot orthosis, plastic or other material, custom fabricated

650.48

487.86

5.3102%

5.3102%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

Total HCPCS

1281.17

960.88

5.3100%

5.3100%

Tamarack Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G200

L1970 - Ankle foot orthosis, plastic with ankle joint, custom fabricated

935.93

701.95

5.3098%

5.3109%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

Total HCPCS

1566.62

1174.97

5.3098%

5.3105%

Overlapping Articulating Gauntlet

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G250

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%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

Total HCPCS

1731.58

1298.69

5.3093%

5.3106%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G300

L1970 - Ankle foot orthosis, plastic with ankle joint, custom fabricated

935.93

701.95

5.3098%

5.3109%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

L2210 - Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

88.41

66.31

5.3001%

5.3041%

L2210 - Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

88.41

66.31

5.3001%

5.3041%

Total HCPCS

1743.44

1307.59

5.3093%

5.3106%

Leather Partial Foot

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G600

L1960 - Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated

729.06

546.80

5.3098%

5.3098%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

L5000 - Partial foot, shoe insert with longitudinal arch, toe filler

708.02

531.01

5.3115%

5.3090%

Total HCPCS

2067.77

1550.83

5.3104%

5.3095%

Balance Brace

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G800

L1940 - Ankle foot orthosis, plastic or other material, custom fabricated

650.48

487.86

5.3102%

5.3102%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

Total HCPCS

1281.17

960.88

5.3100%

5.3100%

Leaf Spring

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T100

L1960 - Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated

729.06

546.80

5.3098%

5.3098%

L2275 - Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined

164.96

123.72

5.3048%

5.3115%

Total HCPCS

894.02

670.52

5.3089%

5.3101%

Solid Ankle

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T150

L1960 - Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated

729.06

546.80

5.3098%

5.3098%

L2275 - Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined

164.96

123.72

5.3048%

5.3115%

Total HCPCS

894.02

670.52

5.3089%

5.3101%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T300

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%

L2210 - Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

88.41

66.31

5.3001%

5.3041%

L2210 - Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint

88.41

66.31

5.3001%

5.3041%

Total HCPCS

1277.71

958.29

5.3078%

5.3101%

Traditional CROW

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C100

L4631 - Ankle foot orthosis, walking boot type, varus/valgus correction, rocker bottom, anterior tibial shell, soft interface, custom arch support, plastic or other material, includes straps and closures, custom fabricated

1938.05

1453.53

5.3105%

5.3099%

Total HCPCS

1938.05

1453.53

5.3105%

5.3099%

Tundra Boot

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C200

L1960 - Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated

729.06

546.80

5.3098%

5.3098%

L1940 - Ankle foot orthosis, plastic or other material, custom fabricated

650.48

487.86

5.3102%

5.3102%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2280 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

595.59

446.69

5.3116%

5.3117%

L2232 - Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only

122.98

92.23

5.3091%

5.2974%

L3400 - Metatarsal bar wedge, rocker

51.15

38.36

5.3119%

5.2978%

Total HCPCS

2779.95

2084.96

5.3103%

5.3095%

Tundra Sandal

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C250

L1960 - Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated

729.06

546.80

5.3098%

5.3098%

L1940 - Ankle foot orthosis, plastic or other material, custom fabricated

650.48

487.86

5.3102%

5.3102%

L2330 - Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only

516.47

387.35

5.3096%

5.3097%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2280 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

595.59

446.69

5.3116%

5.3117%

L2232 - Addition to lower extremity orthosis, rocker bottom for total contact ankle foot orthosis, for custom fabricated orthosis only

122.98

92.23

5.3091%

5.2974%

L3400 - Metatarsal bar wedge, rocker

51.15

38.36

5.3119%

5.2978%

Total HCPCS

2779.95

2084.96

5.3103%

5.3095%

Dorsiflex Posterior

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

D100

L1945 - Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated

1217.57

913.18

5.3106%

5.3106%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2755 - Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

164.19

123.14

5.3108%

5.3109%

L2755 - Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

164.19

123.14

5.3108%

5.3109%

Total HCPCS

1660.17

1245.13

5.3107%

5.3107%

Dorsiflex Anterior

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

D110

L1945 - Ankle foot orthosis, plastic, rigid anterior tibial section (floor reaction), custom fabricated

1217.57

913.18

5.3106%

5.3106%

L2820 - Addition to lower extremity orthosis, soft interface for molded plastic, below knee section

114.22

85.67

5.3107%

5.3104%

L2755 - Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

164.19

123.14

5.3108%

5.3109%

L2755 - Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only

164.19

123.14

5.3108%

5.3109%

Total HCPCS

1660.17

1245.13

5.3107%

5.3107%

 

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

ADDITIONAL
CODES

L2270 - Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad

70.64

52.98

5.3071%

5.3071%

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%

L2350 - Addition to lower extremity, prosthetic type, (bk) socket, molded to patient model, (used for 'ptb' 'afo' orthoses)

1172.01

879.01

5.3104%

5.3110%

AFO Product DMEPOS By State Fee Schedule 2022

Comparison spreadsheet
2022 spreadsheet
2020 spreadsheet