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Same or Similar

AFO Product DMEPOS By State Fee Schedule 2023

AFO Product DMEPOS By State Fee Schedule 2023

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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

1147.17

860.38

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

Total HCPCS

1271.33

953.50

8.7%

8.7%

Tamarack Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A200

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

1017.36

763.02

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

Total HCPCS

1320.83

990.62

8.7%

8.7%

Tamarack Free Motion Calf Lacer

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A200L

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

1017.36

763.02

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

Total HCPCS

1882.23

1411.67

8.7%

8.7%

Overlap Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A250

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

1017.36

763.02

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

Total HCPCS

1320.83

990.62

8.7%

8.7%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A300

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

1017.36

763.02

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

96.11

72.08

8.7%

8.7%

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

96.11

72.08

8.7%

8.7%

Total HCPCS

1513.05

1134.78

8.7%

8.7%

Cabbie

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G50

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

768.61

576.46

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

Total HCPCS

1330.01

997.51

8.7%

8.7%

Short

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G100

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

707.08

530.31

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

Total HCPCS

1392.64

1044.48

8.7%

8.7%

Standard

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G120

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

707.08

530.31

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

Total HCPCS

1392.64

1044.48

8.7%

8.7%

Tall

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G140

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

707.08

530.31

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

Total HCPCS

1392.64

1044.48

8.7%

8.7%

Tamarack Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G200

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

1017.36

763.02

8.7004%

8.7%

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

124.16

93.12

8.7025%

8.7%

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

561.40

421.05

8.6994%

8.7%

Total HCPCS

1702.92

1277.19

8.7003%

8.7%

Overlapping Articulating Gauntlet

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G250

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

1017.36

763.02

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

Total HCPCS

1882.23

1411.67

8.7%

8.7%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G300

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

1017.36

763.02

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

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

96.11

72.08

8.7%

8.7%

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

96.11

72.08

8.7%

8.7%

Total HCPCS

1895.14

1421.35

8.7%

8.7%

Leather Partial Foot

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G600

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

792.49

594.37

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

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

769.61

577.21

8.7%

8.7%

Total HCPCS

2247.66

1685.75

8.7%

8.7%

Balance Brace

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G800

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

707.08

530.31

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

516.47

421.05

8.7%

8.7%

Total HCPCS

1281.17

1044.48

8.7%

8.7%

Leaf Spring

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T100

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

792.49

594.37

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

Total HCPCS

971.80

728.85

8.7%

8.7%

Solid Ankle

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T150

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

792.49

594.37

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

Total HCPCS

971.80

728.85

8.7%

8.7%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T300

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

1017.36

763.02

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

96.11

72.08

8.7%

8.7%

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

96.11

72.08

8.7%

8.7%

Total HCPCS

1388.89

1041.66

8.7%

8.7%

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

2106.66

1579.99

8.7%

8.7%

Total HCPCS

2106.66

1579.99

8.7%

8.7%

Tundra Boot

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C200

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

792.49

594.37

8.7%

8.7%

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

707.08

530.31

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

647.40

485.55

8.7%

8.7%

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

133.68

100.26

8.7%

8.7%

L3400 - Metatarsal bar wedge, rocker

55.60

41.70

8.7%

8.7%

Total HCPCS

3021.81

2266.36

8.7%

8.7%

Tundra Sandal

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C250

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

792.49

594.37

8.7%

8.7%

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

707.08

530.31

8.7%

8.7%

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

561.40

421.05

8.7%

8.7%

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

647.40

485.55

8.7%

8.7%

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

133.68

100.26

8.7%

8.7%

L3400 - Metatarsal bar wedge, rocker

55.60

41.70

8.7%

8.7%

Total HCPCS

3021.81

2266.36

8.7%

8.7%

Dorsiflex Posterior

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

D100

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

1323.50

992.62

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

178.48

133.86

8.7%

8.7%

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

178.48

133.86

8.7%

8.7%

Total HCPCS

1804.62

1353.46

8.7%

8.7%

Dorsiflex Anterior

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

D110

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

1323.50

992.62

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

178.48

133.86

8.7%

8.7%

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

178.48

133.86

8.7%

8.7%

Total HCPCS

1804.62

1353.46

8.7%

8.7%

 

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

ADDITIONAL
CODES

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

76.78

57.59

8.7%

8.7%

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

179.31

134.48

8.7%

8.7%

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

124.16

93.12

8.7%

8.7%

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

1273.97

955.48

8.7%

8.7%

AFO Product DMEPOS By State Fee Schedule 2023