A code page states the long descriptor and, where a person has read the governing documents, the coverage determination and policy article that govern the code, the monthly quantity ceiling and the published Medicare allowable, each cited to the document it was read from.
Most pages are summaries. A summary page has had its descriptor checked against the HCPCS register and nothing else, and it says so at the top. The Governing Det. column is blank where no policy has been read for the code, and the Med Allowable column is blank where the fee schedule has not been read. A blank is an absence of reading, not a statement that nothing applies.
Where a page and the governing determination disagree, the determination is right and the page is wrong. Every page names its sources so the governing text can be read directly. What is not here is a commercial rate. No figure taken from a payer machine-readable file appears on any of these pages.
156 codesMedicare allowables from the CMS DMEPOS fee schedule, October 2026. Payer rates for these codes are in the app, refreshed monthly. Latest file month: November 2026.
| Code | Description | Category | Governing Det. | Med Allowable | Last Checked |
|---|---|---|---|---|---|
| A4217 | Sterile water/saline, 500 ml | Urological | $4.4725 states | 2026-11-05 | |
| A4295 | Intermittent urinary catheter; straight tip, hydrophilic coating, each | Hydrophilic Catheters | L33803, A52521 | $2.5825 states | 2026-08-07 |
| A4296 | Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each | Hydrophilic Catheters | L33803, A52521 | $9.1524 states, the District of Columbia and the U.S. Virgin Islands | 2026-08-07 |
| A4297 | Intermittent urinary catheter; hydrophilic coating, with insertion supplies | Hydrophilic Catheters | L33803, A52521 | $9.9931 states and the U.S. Virgin Islands | 2026-08-07 |
| A4310 | Insertion tray without drainage bag and without catheter (accessories only) | Urological | $11.0126 states and the U.S. Virgin Islands | 2026-11-05 | |
| A4320 | Irrigation tray with bulb or piston syringe, any purpose | Urological | $7.6125 states | 2026-11-05 | |
| A4322 | Irrigation syringe, bulb or piston, each | Urological | $4.3525 states and the U.S. Virgin Islands | 2026-11-05 | |
| A4326 | Male external catheter with integral collection chamber, any type, each | Urological | $15.3724 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4327 | Female external urinary collection device; meatal cup, each | Urological | $63.5726 states and the U.S. Virgin Islands | 2026-11-05 | |
| A4328 | Female external urinary collection device; pouch, each | Urological | $14.8724 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4332 | Lubricant, individual sterile packet, each | Urological | $0.1549 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4333 | Urinary catheter anchoring device, adhesive skin attachment, each | Urological | $3.1648 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4334 | Urinary catheter anchoring device, leg strap, each | Urological | $7.0148 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4349 | Male external catheter, with or without adhesive, disposable, each | Urological | $2.8748 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating | Urological | L33803, A52521 | $2.5825 states | 2026-08-07 |
| A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating | Urological | L33803, A52521 | $9.1524 states, the District of Columbia and the U.S. Virgin Islands | 2026-08-07 |
| A4353 | Intermittent urinary catheter, with insertion supplies | Urological | L33803, A52521 | $9.9931 states and the U.S. Virgin Islands | 2026-08-07 |
| A4354 | Insertion tray with drainage bag but without catheter | Urological | $16.8325 states | 2026-11-05 | |
| A4355 | Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each | Urological | $12.7125 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4356 | External urethral clamp or compression device (not to be used for catheter clamp), each | Urological | $65.0324 states and the District of Columbia | 2026-11-05 | |
| A4358 | Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each | Urological | $9.4625 states and the District of Columbia | 2026-11-05 | |
| A4361 | Ostomy faceplate, each | Ostomy Supplies | $26.1625 states | 2026-11-05 | |
| A4362 | Skin barrier; solid, 4 x 4 or equivalent; each | Ostomy Supplies | $4.9524 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4363 | Ostomy clamp, any type, replacement only, each | Ostomy Supplies | $3.3824 states and the District of Columbia | 2026-11-05 | |
| A4364 | Adhesive, liquid or equal, any type, per oz | Ostomy Supplies | $4.1928 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4366 | Ostomy vent, any type, each | Ostomy Supplies | $1.8450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4367 | Ostomy belt, each | Ostomy Supplies | $10.4924 states and the District of Columbia | 2026-11-05 | |
| A4368 | Ostomy filter, any type, each | Ostomy Supplies | $0.3649 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4369 | Ostomy skin barrier, liquid (spray, brush, etc.), per oz | Ostomy Supplies | $3.4633 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4371 | Ostomy skin barrier, powder, per oz | Ostomy Supplies | $5.2033 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4372 | Ostomy skin barrier, solid 4 x 4 or equivalent, standard wear, with built-in convexity, each | Ostomy Supplies | $5.9948 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4373 | Ostomy skin barrier, with flange (solid, flexible or accordion), with built-in convexity, any size, each | Ostomy Supplies | $8.9448 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4375 | Ostomy pouch, drainable, with faceplate attached, plastic, each | Ostomy Supplies | $24.4748 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4376 | Ostomy pouch, drainable, with faceplate attached, rubber, each | Ostomy Supplies | $67.8148 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4377 | Ostomy pouch, drainable, for use on faceplate, plastic, each | Ostomy Supplies | $6.1148 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4378 | Ostomy pouch, drainable, for use on faceplate, rubber, each | Ostomy Supplies | $43.8248 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4379 | Ostomy pouch, urinary, with faceplate attached, plastic, each | Ostomy Supplies | $21.4048 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4380 | Ostomy pouch, urinary, with faceplate attached, rubber, each | Ostomy Supplies | $53.2048 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4381 | Ostomy pouch, urinary, for use on faceplate, plastic, each | Ostomy Supplies | $6.5948 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4382 | Ostomy pouch, urinary, for use on faceplate, heavy plastic, each | Ostomy Supplies | $35.0948 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4383 | Ostomy pouch, urinary, for use on faceplate, rubber, each | Ostomy Supplies | $40.1748 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4384 | Ostomy faceplate equivalent, silicone ring, each | Ostomy Supplies | $13.6948 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4385 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each | Ostomy Supplies | $7.2648 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4387 | Ostomy pouch, closed, with barrier attached, with built-in convexity (1 piece), each | Ostomy Supplies | $3.2050 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4388 | Ostomy pouch, drainable, with extended wear barrier attached, (1 piece), each | Ostomy Supplies | $6.2148 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4389 | Ostomy pouch, drainable, with barrier attached, with built-in convexity (1 piece), each | Ostomy Supplies | $8.8448 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4390 | Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each | Ostomy Supplies | $13.6848 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4391 | Ostomy pouch, urinary, with extended wear barrier attached (1 piece), each | Ostomy Supplies | $10.0748 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4392 | Ostomy pouch, urinary, with standard wear barrier attached, with built-in convexity (1 piece), each | Ostomy Supplies | $11.6550 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4393 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity (1 piece), each | Ostomy Supplies | $12.8850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4394 | Ostomy deodorant, with or without lubricant, for use in ostomy pouch, per fluid ounce | Ostomy Supplies | $3.6948 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4395 | Ostomy deodorant for use in ostomy pouch, solid, per tablet | Ostomy Supplies | $0.0550 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4396 | Ostomy belt with peristomal hernia support | Ostomy Supplies | $57.6950 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4398 | Ostomy irrigation supply; bag, each | Ostomy Supplies | $19.7034 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4399 | Ostomy irrigation supply; cone/catheter, with or without brush | Ostomy Supplies | $17.4829 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4404 | Ostomy ring, each | Ostomy Supplies | $2.3927 states and the U.S. Virgin Islands | 2026-11-05 | |
| A4405 | Ostomy skin barrier, non-pectin based, paste, per ounce | Ostomy Supplies | $4.8750 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4406 | Ostomy skin barrier, pectin-based, paste, per ounce | Ostomy Supplies | $8.1650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4407 | Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each | Ostomy Supplies | $12.4850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4408 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, with built-in convexity, larger than 4 x 4 inches, each | Ostomy Supplies | $14.0750 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4409 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each | Ostomy Supplies | $8.8450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4410 | Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, larger than 4 x 4 inches, each | Ostomy Supplies | $12.8850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4411 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, with built-in convexity, each | Ostomy Supplies | $7.2650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4412 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), without filter, each | Ostomy Supplies | $3.8650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4413 | Ostomy pouch, drainable, high output, for use on a barrier with flange (2 piece system), with filter, each | Ostomy Supplies | $7.8550 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4414 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, 4 x 4 inches or smaller, each | Ostomy Supplies | $7.0150 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4415 | Ostomy skin barrier, with flange (solid, flexible or accordion), without built-in convexity, larger than 4 x 4 inches, each | Ostomy Supplies | $8.5550 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4416 | Ostomy pouch, closed, with barrier attached, with filter (1 piece), each | Ostomy Supplies | $3.9350 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4417 | Ostomy pouch, closed, with barrier attached, with built-in convexity, with filter (1 piece), each | Ostomy Supplies | $5.3150 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4418 | Ostomy pouch, closed; without barrier attached, with filter (1 piece), each | Ostomy Supplies | $2.5850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4419 | Ostomy pouch, closed; for use on barrier with non-locking flange, with filter (2 piece), each | Ostomy Supplies | $2.4650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4422 | Ostomy absorbent material (sheet/pad/crystal packet) for use in ostomy pouch to thicken liquid stomal output, each | Ostomy Supplies | $0.1550 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4423 | Ostomy pouch, closed; for use on barrier with locking flange, with filter (2 piece), each | Ostomy Supplies | $2.6450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4424 | Ostomy pouch, drainable, with barrier attached, with filter (1 piece), each | Ostomy Supplies | $6.7850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4425 | Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each | Ostomy Supplies | $5.1050 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4426 | Ostomy pouch, drainable; for use on barrier with locking flange (2 piece system), each | Ostomy Supplies | $3.8950 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4427 | Ostomy pouch, drainable; for use on barrier with locking flange, with filter (2 piece system), each | Ostomy Supplies | $3.9850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4428 | Ostomy pouch, urinary, with extended wear barrier attached, with faucet-type tap with valve (1 piece), each | Ostomy Supplies | $9.2950 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4429 | Ostomy pouch, urinary, with barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each | Ostomy Supplies | $11.7650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4430 | Ostomy pouch, urinary, with extended wear barrier attached, with built-in convexity, with faucet-type tap with valve (1 piece), each | Ostomy Supplies | $12.1450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4431 | Ostomy pouch, urinary; with barrier attached, with faucet-type tap with valve (1 piece), each | Ostomy Supplies | $8.8450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4432 | Ostomy pouch, urinary; for use on barrier with non-locking flange, with faucet-type tap with valve (2 piece), each | Ostomy Supplies | $5.1150 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4433 | Ostomy pouch, urinary; for use on barrier with locking flange (2 piece), each | Ostomy Supplies | $4.7850 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4434 | Ostomy pouch, urinary; for use on barrier with locking flange, with faucet-type tap with valve (2 piece), each | Ostomy Supplies | $5.3650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4435 | Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each | Ostomy Supplies | $8.2148 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A4436 | Irrigation supply; sleeve, reusable, per month | Ostomy Supplies | $27.3324 states and the District of Columbia | 2026-11-05 | |
| A4437 | Irrigation supply; sleeve, disposable, per month | Ostomy Supplies | $27.3324 states and the District of Columbia | 2026-11-05 | |
| A4453 | Rectal catheter for use with any type transanal irrigation system | Advanced Catheter (TAI) | L36267, A54516 | $14.04All 53 jurisdictions the file lists | 2026-08-07 |
| A4459 | Manual transanal irrigation system, without catheter | Advanced Catheter (TAI) | L36267, A54516 | $160.42All 53 jurisdictions the file lists | 2026-08-07 |
| A4479 | Electronic transanal irrigation system, without catheter | Advanced Catheter (TAI) | L36267, A54516 | $706.38All 53 jurisdictions the file lists | 2026-08-07 |
| A5051 | Ostomy pouch, closed; with barrier attached (1 piece), each | Ostomy Supplies | $2.9450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5052 | Ostomy pouch, closed; without barrier attached (1 piece), each | Ostomy Supplies | $2.1250 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5053 | Ostomy pouch, closed; for use on faceplate, each | Ostomy Supplies | $2.4624 states and the District of Columbia | 2026-11-05 | |
| A5054 | Ostomy pouch, closed; for use on barrier with flange (2 piece), each | Ostomy Supplies | $2.5650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5055 | Stoma cap | Ostomy Supplies | $2.0524 states and the District of Columbia | 2026-11-05 | |
| A5056 | Ostomy pouch, drainable, with extended wear barrier attached, with filter, (1 piece), each | Ostomy Supplies | $6.6650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5057 | Ostomy pouch, drainable, with extended wear barrier attached, with built in convexity, with filter, (1 piece), each | Ostomy Supplies | $13.6848 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5061 | Ostomy pouch, drainable; with barrier attached, (1 piece), each | Ostomy Supplies | $5.0450 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5062 | Ostomy pouch, drainable; without barrier attached (1 piece), each | Ostomy Supplies | $3.1825 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5063 | Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each | Ostomy Supplies | $3.8650 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5071 | Ostomy pouch, urinary; with barrier attached (1 piece), each | Ostomy Supplies | $8.5750 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5072 | Ostomy pouch, urinary; without barrier attached (1 piece), each | Ostomy Supplies | $5.0424 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5073 | Ostomy pouch, urinary; for use on barrier with flange (2 piece), each | Ostomy Supplies | $4.5325 states and the District of Columbia | 2026-11-05 | |
| A5081 | Stoma plug or seal, any type | Ostomy Supplies | $4.7224 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5082 | Continent device; catheter for continent stoma | Ostomy Supplies | $16.9629 states and the District of Columbia | 2026-11-05 | |
| A5083 | Continent device, stoma absorptive cover for continent stoma | Ostomy Supplies | $0.9250 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5093 | Ostomy accessory; convex insert | Ostomy Supplies | $2.7827 states | 2026-11-05 | |
| A5105 | Urinary suspensory with leg bag, with or without tube, each | Urological | $58.1125 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5112 | Urinary drainage bag, leg or abdomen, latex, with or without tube, with straps, each | Urological | $49.3526 states | 2026-11-05 | |
| A5113 | Leg strap; latex, replacement only, per set | Urological | $6.7124 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5114 | Leg strap; foam or fabric, replacement only, per set | Urological | $12.7524 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5120 | Skin barrier, wipes or swabs, each | Ostomy Supplies | $0.3528 states, the District of Columbia and the U.S. Virgin Islands | 2026-11-05 | |
| A5121 | Skin barrier; solid, 6 x 6 or equivalent, each | Ostomy Supplies | $10.6226 states | 2026-11-05 | |
| A5122 | Skin barrier; solid, 8 x 8 or equivalent, each | Ostomy Supplies | $18.3025 states | 2026-11-05 | |
| A5126 | Adhesive or non-adhesive; disk or foam pad | Ostomy Supplies | $1.8728 states and the District of Columbia | 2026-11-05 | |
| A5200 | Percutaneous catheter/tube anchoring device, adhesive skin attachment | Urological | $16.1228 states and the U.S. Virgin Islands | 2026-11-05 | |
| L0450 | Tlso, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf | OTS Back | $145.1018 states | 2026-11-05 | |
| L0455 | Tlso, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf | OTS Back | $269.3718 states | 2026-11-05 | |
| L0457 | Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf | OTS Back | $772.4618 states | 2026-11-05 | |
| L0467 | Tlso, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf | OTS Back | $302.1018 states | 2026-11-05 | |
| L0469 | Tlso, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf | OTS Back | $384.9318 states | 2026-11-05 | |
| L0621 | Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $76.5018 states | 2026-11-05 | |
| L0623 | Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $137.1318 states | 2026-11-05 | |
| L0625 | Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf | OTS Back | $42.8018 states | 2026-11-05 | |
| L0628 | Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $65.1718 states | 2026-11-05 | |
| L0641 | Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $60.5518 states | 2026-11-05 | |
| L0642 | Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $319.3318 states | 2026-11-05 | |
| L0643 | Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $125.8118 states | 2026-11-05 | |
| L0648 | Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $797.4918 states | 2026-11-05 | |
| L0649 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $222.7718 states | 2026-11-05 | |
| L0650 | Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $922.7518 states | 2026-11-05 | |
| L0651 | Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf | OTS Back | $922.7518 states | 2026-11-05 | |
| L1812 | Knee orthosis, elastic with joints, prefabricated, off-the-shelf | OTS Knee | $85.7112 states | 2026-11-05 | |
| L1821 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated, off the shelf | OTS Knee | $148.998 states | 2026-11-05 | |
| L1830 | Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf | OTS Knee | $77.2312 states | 2026-11-05 | |
| L1833 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf | OTS Knee | $556.3112 states | 2026-11-05 | |
| L1836 | Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, off-the-shelf | OTS Knee | $109.2012 states | 2026-11-05 | |
| L1850 | Knee orthosis, swedish type, prefabricated, off-the-shelf | OTS Knee | $251.5012 states | 2026-11-05 | |
| L1851 | Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf | OTS Knee | $734.2812 states | 2026-11-05 | |
| L1852 | Knee orthosis (ko), double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf | OTS Knee | $700.4912 states | 2026-11-05 | |
| L3650 | Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf | OTS Upper Extremity | $67.318 states | 2026-11-05 | |
| L3660 | Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf | OTS Upper Extremity | $115.5727 states and the District of Columbia | 2026-11-05 | |
| L3670 | Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf | OTS Upper Extremity | $127.1518 states | 2026-11-05 | |
| L3675 | Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf | OTS Upper Extremity | $191.5821 states and the District of Columbia | 2026-11-05 | |
| L3710 | Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf | OTS Upper Extremity | $139.0113 states | 2026-11-05 | |
| L3761 | Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, off-the-shelf | OTS Upper Extremity | $545.9021 states and the District of Columbia | 2026-11-05 | |
| L3762 | Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf | OTS Upper Extremity | $117.3821 states and the District of Columbia | 2026-11-05 | |
| L3809 | Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type | OTS Upper Extremity | $272.9721 states and the District of Columbia | 2026-11-05 | |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | OTS Upper Extremity | $67.3719 states | 2026-11-05 | |
| L3912 | Hand finger orthosis (hfo), flexion glove with elastic finger control, prefabricated, off-the-shelf | OTS Upper Extremity | $106.6414 states and the U.S. Virgin Islands | 2026-11-05 | |
| L3916 | Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf | OTS Upper Extremity | $580.2821 states and the District of Columbia | 2026-11-05 | |
| L3918 | Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf | OTS Upper Extremity | $115.3721 states and the District of Columbia | 2026-11-05 | |
| L3924 | Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-the-shelf | OTS Upper Extremity | $97.8124 states and the U.S. Virgin Islands | 2026-11-05 | |
| L3925 | Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf | OTS Upper Extremity | $55.508 states and the U.S. Virgin Islands | 2026-11-05 | |
| L3927 | Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/spring, extension/flexion (e.g., static or ring type), may include soft interface material, prefabricated, off-the-shelf | OTS Upper Extremity | $38.1713 states and the District of Columbia | 2026-11-05 | |
| L3930 | Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps, prefabricated, off-the-shelf | OTS Upper Extremity | $87.9014 states and the U.S. Virgin Islands | 2026-11-05 |