2026 DME Fee Schedule for L1902

Durable Medical Equipment, Prosthetics / Orthotics, and Supplies & Parenteral and Enteral Nutrition Items and Services

Fees shown below are effective July 1, 2025

HCPCS code L1902 - Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf

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The DMEPOS fee schedule contains fee schedule amounts for each procedure code subject to fee schedule payment methodologies. Beginning January 1, 2016, the data will also contain fee schedule amounts for certain procedure codes that have been adjusted using information from the competitive bidding programs. Note: Fee schedule amounts for those codes not adjusted using competitive bidding information will only have fee schedule amounts in the non-rural columns.

See also Ambulance Fee Schedule · Carrier Locality Codes

Prosthetics / Orthotics, and Supplies
Year State Code Modifier 2nd Modifier Jurisdiction Category Floor Ceiling Rural Fee Non-rural Fee
2026 AK L1902 D PO 91.73 122.31 n/a $108.65
2026 AL L1902 D PO 91.73 122.31 n/a $94.39
2026 AR L1902 D PO 91.73 122.31 n/a $122.31
2026 AZ L1902 D PO 91.73 122.31 n/a $105.11
2026 CA L1902 D PO 91.73 122.31 n/a $105.11
2026 CO L1902 D PO 91.73 122.31 n/a $91.73
2026 CT L1902 D PO 91.73 122.31 n/a $105.66
2026 DC L1902 D PO 91.73 122.31 n/a $107.12
2026 DE L1902 D PO 91.73 122.31 n/a $107.12
2026 FL L1902 D PO 91.73 122.31 n/a $94.39
2026 GA L1902 D PO 91.73 122.31 n/a $94.39
2026 HI L1902 D PO 91.73 122.31 n/a $116.17
2026 IA L1902 D PO 91.73 122.31 n/a $96.81
2026 ID L1902 D PO 91.73 122.31 n/a $112.48
2026 IL L1902 D PO 91.73 122.31 n/a $91.73
2026 IN L1902 D PO 91.73 122.31 n/a $91.73
2026 KS L1902 D PO 91.73 122.31 n/a $96.81
2026 KY L1902 D PO 91.73 122.31 n/a $94.39
2026 LA L1902 D PO 91.73 122.31 n/a $122.31
2026 MA L1902 D PO 91.73 122.31 n/a $105.66
2026 MD L1902 D PO 91.73 122.31 n/a $107.12
2026 ME L1902 D PO 91.73 122.31 n/a $105.66
2026 MI L1902 D PO 91.73 122.31 n/a $91.73
2026 MN L1902 D PO 91.73 122.31 n/a $91.73
2026 MO L1902 D PO 91.73 122.31 n/a $96.81
2026 MS L1902 D PO 91.73 122.31 n/a $94.39
2026 MT L1902 D PO 91.73 122.31 n/a $91.73
2026 NC L1902 D PO 91.73 122.31 n/a $94.39
2026 ND L1902 D PO 91.73 122.31 n/a $91.73
2026 NE L1902 D PO 91.73 122.31 n/a $96.81
2026 NH L1902 D PO 91.73 122.31 n/a $105.66
2026 NJ L1902 D PO 91.73 122.31 n/a $120.04
2026 NM L1902 D PO 91.73 122.31 n/a $122.31
2026 NV L1902 D PO 91.73 122.31 n/a $105.11
2026 NY L1902 D PO 91.73 122.31 n/a $120.04
2026 OH L1902 D PO 91.73 122.31 n/a $91.73
2026 OK L1902 D PO 91.73 122.31 n/a $122.31
2026 OR L1902 D PO 91.73 122.31 n/a $112.48
2026 PA L1902 D PO 91.73 122.31 n/a $107.12
2026 PR L1902 D PO 91.73 122.31 n/a $85.68
2026 RI L1902 D PO 91.73 122.31 n/a $105.66
2026 SC L1902 D PO 91.73 122.31 n/a $94.39
2026 SD L1902 D PO 91.73 122.31 n/a $91.73
2026 TN L1902 D PO 91.73 122.31 n/a $94.39
2026 TX L1902 D PO 91.73 122.31 n/a $122.31
2026 UT L1902 D PO 91.73 122.31 n/a $91.73
2026 VA L1902 D PO 91.73 122.31 n/a $107.12
2026 VI L1902 D PO 91.73 122.31 n/a $120.02
2026 VT L1902 D PO 91.73 122.31 n/a $105.66
2026 WA L1902 D PO 91.73 122.31 n/a $112.48
2026 WI L1902 D PO 91.73 122.31 n/a $91.73
2026 WV L1902 D PO 91.73 122.31 n/a $107.12
2026 WY L1902 D PO 91.73 122.31 n/a $91.73
Prosthetics / Orthotics, and Supplies
Year State Code Modifier 2nd Modifier Jurisdiction Category Floor Ceiling Rural Fee Non-rural Fee
2025 AK L1902 D PO 89.93 119.91 n/a $106.52
2025 AL L1902 D PO 89.93 119.91 n/a $92.54
2025 AR L1902 D PO 89.93 119.91 n/a $119.91
2025 AZ L1902 D PO 89.93 119.91 n/a $103.05
2025 CA L1902 D PO 89.93 119.91 n/a $103.05
2025 CO L1902 D PO 89.93 119.91 n/a $89.93
2025 CT L1902 D PO 89.93 119.91 n/a $103.59
2025 DC L1902 D PO 89.93 119.91 n/a $105.02
2025 DE L1902 D PO 89.93 119.91 n/a $105.02
2025 FL L1902 D PO 89.93 119.91 n/a $92.54
2025 GA L1902 D PO 89.93 119.91 n/a $92.54
2025 HI L1902 D PO 89.93 119.91 n/a $113.89
2025 IA L1902 D PO 89.93 119.91 n/a $94.91
2025 ID L1902 D PO 89.93 119.91 n/a $110.27
2025 IL L1902 D PO 89.93 119.91 n/a $89.93
2025 IN L1902 D PO 89.93 119.91 n/a $89.93
2025 KS L1902 D PO 89.93 119.91 n/a $94.91
2025 KY L1902 D PO 89.93 119.91 n/a $92.54
2025 LA L1902 D PO 89.93 119.91 n/a $119.91
2025 MA L1902 D PO 89.93 119.91 n/a $103.59
2025 MD L1902 D PO 89.93 119.91 n/a $105.02
2025 ME L1902 D PO 89.93 119.91 n/a $103.59
2025 MI L1902 D PO 89.93 119.91 n/a $89.93
2025 MN L1902 D PO 89.93 119.91 n/a $89.93
2025 MO L1902 D PO 89.93 119.91 n/a $94.91
2025 MS L1902 D PO 89.93 119.91 n/a $92.54
2025 MT L1902 D PO 89.93 119.91 n/a $89.93
2025 NC L1902 D PO 89.93 119.91 n/a $92.54
2025 ND L1902 D PO 89.93 119.91 n/a $89.93
2025 NE L1902 D PO 89.93 119.91 n/a $94.91
2025 NH L1902 D PO 89.93 119.91 n/a $103.59
2025 NJ L1902 D PO 89.93 119.91 n/a $117.69
2025 NM L1902 D PO 89.93 119.91 n/a $119.91
2025 NV L1902 D PO 89.93 119.91 n/a $103.05
2025 NY L1902 D PO 89.93 119.91 n/a $117.69
2025 OH L1902 D PO 89.93 119.91 n/a $89.93
2025 OK L1902 D PO 89.93 119.91 n/a $119.91
2025 OR L1902 D PO 89.93 119.91 n/a $110.27
2025 PA L1902 D PO 89.93 119.91 n/a $105.02
2025 PR L1902 D PO 89.93 119.91 n/a $84.00
2025 RI L1902 D PO 89.93 119.91 n/a $103.59
2025 SC L1902 D PO 89.93 119.91 n/a $92.54
2025 SD L1902 D PO 89.93 119.91 n/a $89.93
2025 TN L1902 D PO 89.93 119.91 n/a $92.54
2025 TX L1902 D PO 89.93 119.91 n/a $119.91
2025 UT L1902 D PO 89.93 119.91 n/a $89.93
2025 VA L1902 D PO 89.93 119.91 n/a $105.02
2025 VI L1902 D PO 89.93 119.91 n/a $117.67
2025 VT L1902 D PO 89.93 119.91 n/a $103.59
2025 WA L1902 D PO 89.93 119.91 n/a $110.27
2025 WI L1902 D PO 89.93 119.91 n/a $89.93
2025 WV L1902 D PO 89.93 119.91 n/a $105.02
2025 WY L1902 D PO 89.93 119.91 n/a $89.93

Rural vs Non-rural Fees

Beginning January 1, 2016, some codes have rural and non-rural adjusted fee schedule amounts based on information from competitive bidding programs. Where applicable, the service location will determine the fee schedule to use for codes that contains both rural and non-rural fees. Otherwise, only the non-rural fee schedule should be used.

Click the Rural Fee to check if the service location is considered rural.

Jurisdiction

  • C - Local Part B Carrier
  • D - DMEMAC
  • J - Joint DMEMAC / Local Carrier

Category

  • CR - Capped Rental Items
  • FS - Frequently Serviced Items
  • IL - Intraocular Lenses
  • IN - Inexpensive and Other Routinely Purchased Items
  • OS - Ostomy, Tracheostomy & Urological Items
  • OX - Oxygen and Oxygen Equipment
  • PE - Parenteral and Enteral Nutrition
  • PO - Prosthetics & Orthotics
  • SC - Splints and Casts
  • SD - Surgical Dressings
  • SU - Supplies
  • TE - Transcutaneous Electrical Nerve Stimulators
  • TS - Therapeutic Shoes