| Jurisdiction A DME MAC | ||||||||||||||
| 2006 DMEPOS Fee Schedule Amounts for Power Mobility Devices | ||||||||||||||
| Effective November 15, 2006 (Revised 12/29/2006) | ||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||
| HCPCS | MOD1 | MOD2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| K0827 | NU | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | $5,330.90 | |
| K0827 | RR | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | $533.09 | |
| K0827 | UE | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | $3,998.18 | |
| K0829 | NU | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | $6,343.70 | |
| K0829 | RR | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | $634.37 | |
| K0829 | UE | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | $4,757.78 | |
| K0864 | NU | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | $11,964.50 | |
| K0864 | RR | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | $1,196.45 | |
| K0864 | UE | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | $8,973.38 | |