AFO Product DMEPOS By State Fee Schedule 2023
XTERN
Richie Brace
Balance
Dorsiflex
Gauntlet
Traditional
CROW
UNFO
XTERN
Richie Brace
Balance
Dorsiflex
Gauntlet
Traditional
CROW
UNFO
Gauntlet
Traditional
CROW
UNFO
XTERN
Richie Brace
Balance
Dorsiflex
AFO Product DMEPOS By State Fee Schedule 2023
Click here to create your copy that you can edit.
To download: Go to File, then Download and click the format of your choice.
2023 Medicare DME fee schedule explanation
The designation of "floor" and "ceiling" attached to each of the fees in the table pertains to geographic differences in the fee schedule. Some areas of the country will have fees closer to the ceiling and others will have fees closer to the floor. All providers within a certain area should receive the same payment for a given HCPCS code, while other providers in other certain areas will receive a different payment. Your expected payment is based on your geographic location. The 50 states are all administered by one of four DME MACs (Medicare Administrative Contractors). These contractors are different from the administrators of Parts A and B Medicare.
To find your DME MAC, the regions are depicted here.
More information on each region can be found here:
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