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AFO Product DMEPOS By State Fee Schedule
2021, 2022 and 2023 Comparison
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20232022-2023 Comparison20222021
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HCPCSDescriptionCeilingFloor
Ceiling % Change
Floor % Change
CeilingFloorCeilingFloor
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Richie Brace
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section.124.1693.128.70%8.70%114.2285.67108.6881.51
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Total HCPCS1141.52856.148.70%8.70%1050.15787.62999.19749.40
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9
XTERN
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L1951Ankle foot orthosis, spiral, (institute of rehabilitative medicine type), plastic or other material, prefabricated, includes fitting and adjustment1147.17860.388.70%8.70%1055.35791.511004.14753.11
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section.124.1693.128.70%8.70%114.2285.67108.6881.51
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Total HCPCS1271.33953.508.70%8.70%1169.57877.181112.82834.62
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A200Tamarack Free
Motion
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2275Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined179.31134.488.70%8.70%164.96123.72156.96117.72
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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Total HCPCS1320.83990.628.70%8.70%1215.11911.341156.15867.12
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A200LTamarack
Free Motion Calf
Lacer
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2275Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined179.31134.488.70%8.70%164.96123.72156.96117.72
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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Total HCPCS1882.231411.678.70%8.70%1731.581298.691647.561235.67
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A250Overlap Free
Motion
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2275Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined179.31134.488.70%8.70%164.96123.72156.96117.72
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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Total HCPCS1320.83990.628.70%8.70%1215.11911.341156.15867.12
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A300Tamarack
Dorsi-Assist
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2275Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined179.31134.488.70%8.70%164.96123.72156.96117.72
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2210Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint.96.1172.088.71%8.70%88.4166.3184.1263.09
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L2210Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint.96.1172.088.71%8.70%88.4166.3184.1263.09
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Total HCPCS1513.051134.788.70%8.70%1391.931043.961324.39993.30
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G50Cabbie
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L1907Ankle foot orthosis, plastic or other material, custom fabricated.768.61576.468.70%8.70%707.10530.32672.78504.59
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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Total HCPCS1330.01997.518.70%8.70%1223.57917.671164.19873.14
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1835.34
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G100Short
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L1940Ankle foot orthosis, plastic or other material, custom fabricated.707.08530.318.70%8.70%650.48487.86618.92464.19
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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Total HCPCS1392.641044.488.70%8.70%1281.17960.881219.01914.25
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G120Standard
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L1940Ankle foot orthosis, plastic or other material, custom fabricated.707.08530.318.70%8.70%650.48487.86618.92464.19
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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Total HCPCS1392.641044.488.70%8.70%1281.17960.881219.01914.25
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G140Tall
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L1940Ankle foot orthosis, plastic or other material, custom fabricated.707.08530.318.70%8.70%650.48487.86618.92464.19
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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Total HCPCS1392.641044.488.70%8.70%1281.17960.881219.01914.25
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G200Tamarack
Free Motion
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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Total HCPCS1702.921277.198.70%8.70%1566.621174.971490.601117.95
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70
G250
Overlapping
Articulating Gauntlet
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L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
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L2275Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined179.31134.488.70%8.70%164.96123.72156.96117.72
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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Total HCPCS1882.231411.678.70%8.70%1731.581298.691647.561235.67
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G300Tamarack
Dorsi-Assist
78
L1970Ankle foot orthosis, plastic with ankle joint, custom fabricated1017.36763.028.70%8.70%935.93701.95890.51667.89
79
L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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L2210Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint96.1172.088.71%8.70%88.4166.3184.1263.09
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L2210Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint96.1172.088.71%8.70%88.4166.3184.1263.09
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Total HCPCS1895.141421.358.70%8.70%1743.441307.591658.841244.13
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G600Leather Partial
Foot
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L1960Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated792.49594.378.70%8.70%729.06546.80693.69520.27
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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L5000Partial foot, shoe insert with longitudinal arch, toe filler769.61577.218.70%8.70%708.02531.01673.66505.24
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Total HCPCS2247.661685.758.70%8.70%2067.771550.831967.441475.57
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92
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G800Balance Brace
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L1940Ankle foot orthosis, plastic or other material, custom fabricated.707.08530.318.70%8.70%650.48487.86618.92464.19
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L2820Addition to lower extremity orthosis, soft interface for molded plastic, below knee section124.1693.128.70%8.70%114.2285.67108.6881.51
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L2330Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only.561.40421.058.70%8.70%516.47387.35491.41368.55
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Total HCPCS1392.641044.488.70%8.70%1281.17960.881219.01914.25
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T100Leaf Spring
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L1960Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated792.49594.378.70%8.70%729.06546.80693.69520.27