| Jurisdiction A DME MAC | ||||||||||||||
| 2007 DMEPOS/PEN Fee Schedule Updates | ||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||
| Oxygen and Oxygen Equipment | ||||||||||||||
| HCPCS | Mod1 | Mod2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| A4608 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | $58.15 | ||
| A4619 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | $1.21 | ||
| E0424 | RR | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | |
| E0431 | RR | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | |
| E0434 | RR | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | $31.79 | |
| E0439 | RR | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | |
| E0441 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | ||
| E0442 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | ||
| E0443 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | ||
| E0444 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | $77.45 | ||
| E1353 | $32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | 32.87 | ||
| E1355 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | $24.75 | ||
| E1390 | RR | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | |
| E1391 | RR | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | $198.40 | |
| E1392 | RR | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | |
| E1405 | RR | $233.47 | $233.47 | $233.47 | $228.21 | $233.47 | $228.21 | $228.21 | $233.47 | $233.47 | $233.47 | $233.47 | $228.21 | |
| E1406 | RR | $214.50 | $214.50 | $214.50 | $214.51 | $214.50 | $214.51 | $214.51 | $214.50 | $214.50 | $214.50 | $214.50 | $214.51 | |
| K0738 | RR | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | $51.63 | |