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 2024

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2024 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

1177

882.75

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

Total HCPCS

1304.39

978.29

2.60%

2.60%

Tamarack Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A200

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

1043.81

782.86

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

124.16

95.54

2.60%

2.60%

Total HCPCS

1355.17

1016.38

2.60%

2.60%

Tamarack Free Motion Calf Lacer

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A200L

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

1043.81

782.86

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

Total HCPCS

1931.17

1448.38

2.60%

2.60%

Overlap Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A250

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

1043.81

782.86

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

Total HCPCS

1355.17

1016.38

2.60%

2.60%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

A300

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

1043.81

782.86

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

98.6

73.95

2.60%

2.60%

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

98.6

73.95

2.60%

2.60%

Total HCPCS

1552.37

1164.28

2.60%

2.60%

Cabbie

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G50

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

788.6

591.45

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

Total HCPCS

1364.60

1023.45

2.60%

2.60%

Short

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G100

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

725.46

544.1

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

Total HCPCS

1428.85

1071.64

2.60%

2.60%

Standard

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G120

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

725.46

544.1

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

Total HCPCS

1428.85

1071.64

2.60%

2.60%

Tall

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G140

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

725.46

544.1

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

Total HCPCS

1428.85

1071.64

2.60%

2.60%

Tamarack Free Motion

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G200

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

1043.81

782.86

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

Total HCPCS

1747.20

1310.40

2.60%

2.60%

Overlapping Articulating Gauntlet

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G250

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

1043.81

782.86

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

Total HCPCS

1931.17

1448.38

2.60%

2.60%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G300

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

1043.81

782.86

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

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

98.6

73.95

2.60%

2.60%

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

98.6

73.95

2.60%

2.60%

Total HCPCS

1944.40

1458.30

2.60%

2.60%

Leather Partial Foot

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G600

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

813.1

609.82

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

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

789.62

592.22

2.60%

2.60%

Total HCPCS

2306.11

1729.58

2.60%

2.60%

Balance Brace

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

G800

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

725.46

544.1

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

Total HCPCS

1428.85

1071.64

2.60%

2.60%

Leaf Spring

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T100

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

813.1

609.82

2.60%

2.60%

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

183.97

134.48

2.60%

2.60%

Total HCPCS

997.07

747.80

2.60%

2.60%

Solid Ankle

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T150

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

813.1

609.82

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

Total HCPCS

997.07

747.80

2.60%

2.60%

Tamarack Dorsi-Assist

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

T300

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

1043.81

782.86

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

98.6

73.95

2.60%

2.60%

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

98.6

73.95

2.60%

2.60%

Total HCPCS

1424.98

1068.74

2.60%

2.60%

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

2161.43

1621.07

2.60%

2.60%

Total HCPCS

1938.05

1453.53

2.60%

2.60%

Tundra Boot

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C200

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

813.1

609.82

2.60%

2.60%

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

725.46

544.1

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

664.23

498.18

2.60%

2.60%

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

137.16

102.87

2.60%

2.60%

L3400 - Metatarsal bar wedge, rocker

57.04

42.78

2.60%

2.60%

Total HCPCS

3100.38

2325.29

2.60%

2.60%

Tundra Sandal

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

C250

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

813.1

609.82

2.60%

2.60%

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

725.46

544.1

2.60%

2.60%

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

576.00

432.00

2.60%

2.60%

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

664.23

498.18

2.60%

2.60%

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

137.16

102.87

2.60%

2.60%

L3400 - Metatarsal bar wedge, rocker

57.04

42.78

2.60%

2.60%

Total HCPCS

3100.38

2325.29

2.60%

2.60%

Dorsiflex Posterior

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

D100

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

1357.91

1018.43

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

183.12

137.34

2.60%

2.60%

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

183.12

137.34

2.60%

2.60%

Total HCPCS

1851.54

1388.65

2.60%

2.60%

Dorsiflex Anterior

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

D110

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

1357.91

1018.43

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

183.12

137.34

2.60%

2.60%

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

183.12

137.34

2.60%

2.60%

Total HCPCS

1851.54

1388.65

2.60%

2.60%

 

HCPCS

CEILING

FLOOR

CEILING % CHANGE

FLOOR % CHANGE

ADDITIONAL
CODES

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

78.78

59.08

2.60%

2.60%

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

183.97

137.98

2.60%

2.60%

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

127.39

95.54

2.60%

2.60%

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

1307.1

980.32

2.60%

2.60%

AFO Product DMEPOS By State Fee Schedule 2024