| Jurisdiction A DME MAC | ||||||||||||||
| 2007 DMEPOS/PEN Fee Schedule Updates (Revised 4/2/07) | ||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||
| Parenteral and Enteral Nutrition | ||||||||||||||
| HCPCS | Mod1 | Mod2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| B4034 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | $6.38 | ||
| B4035 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | $12.16 | ||
| B4036 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | $8.34 | ||
| B4081 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | $22.55 | ||
| B4082 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | $16.78 | ||
| B4083 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | $2.57 | ||
| B4086 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | $37.22 | ||
| B4149 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | $1.64 | ||
| B4150 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | $0.70 | ||
| B4152 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | $0.58 | ||
| B4153 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | $1.99 | ||
| B4154 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | $1.27 | ||
| B4155 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | $0.99 | ||
| B4164 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | $17.19 | ||
| B4168 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | $25.04 | ||
| B4176 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | $48.46 | ||
| B4178 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | $58.18 | ||
| B4180 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | $24.65 | ||
| B4185 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | $11.36 | ||
| B4189 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | $179.72 | ||
| B4193 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | $232.24 | ||
| B4197 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | $282.74 | ||
| B4199 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | $323.09 | ||
| B4216 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | $7.81 | ||
| B4220 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | $8.09 | ||
| B4222 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | $9.98 | ||
| B4224 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | $25.29 | ||
| B5000 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | $12.02 | ||
| B5100 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | $4.70 | ||
| B9000 | NU | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | |
| B9000 | RR | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | $117.53 | |
| B9000 | UE | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | |
| B9002 | NU | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | $1,278.99 | |
| B9002 | RR | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | $123.88 | |
| B9002 | UE | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | $959.24 | |
| B9004 | NU | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | |
| B9004 | RR | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | |
| B9004 | UE | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | |
| B9006 | NU | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | $2,551.22 | |
| B9006 | RR | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | $403.88 | |
| B9006 | UE | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | $1,913.41 | |
| E0776 | NU | BA | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 | $106.37 |
| E0776 | RR | BA | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 | $26.92 |
| E0776 | UE | BA | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 | $79.78 |