Jurisdiction A DME MAC
1st Quarter 2006 DMEPOS/PEN Fee Schedule Updates
Revised October 1, 2006
Inclusion of a fee schedule amount for an item does not necessarily indicate coverage
MOD1 MOD2 CT DC DE MA MD ME NH NJ NY PA RI VT
E1238 NU $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73 $1,638.73
E1238 RR $163.87 $163.87 $163.87 $163.87 $163.87 $163.87 $163.87 $163.87 $163.87 $163.87 $163.87 $163.87
E1238 UE $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05 $1,229.05
E2620 NU $547.70 $547.70 $547.70 $547.70 $547.70 $547.70 $547.70 $547.70 $547.70 $547.70 $547.70 $547.70
E2620 RR $54.77 $54.77 $54.77 $54.77 $54.77 $54.77 $54.77 $54.77 $54.77 $54.77 $54.77 $54.77
E2620 UE $410.79 $410.79 $410.79 $410.79 $410.79 $410.79 $410.79 $410.79 $410.79 $410.79 $410.79 $410.79
E2621 NU $574.76 $574.76 $574.76 $574.76 $574.76 $574.76 $574.76 $574.76 $574.76 $574.76 $574.76 $574.76
E2621 RR $57.47 $57.47 $57.47 $57.47 $57.47 $57.47 $57.47 $57.47 $57.47 $57.47 $57.47 $57.47
E2621 UE $431.08 $431.08 $431.08 $431.08 $431.08 $431.08 $431.08 $431.08 $431.08 $431.08 $431.08 $431.08
K0738 RR $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.80 $32.07
L2232 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20 $78.20