| 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 | ||||||||||||||
| Supplies | ||||||||||||||
| HCPCS | Mod1 | Mod2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| A4217 | $3.13 | $2.78 | $3.13 | $2.66 | $3.13 | $2.66 | $2.66 | $3.13 | $2.66 | $3.13 | $2.66 | $3.05 | ||
| A4221 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | $22.64 | ||
| A4222 | $46.73 | $44.94 | $46.73 | $46.73 | $44.94 | $46.73 | $46.73 | $46.73 | $46.73 | $46.73 | $46.73 | $46.73 | ||
| A4255 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | $3.91 | ||
| A4256 | $11.44 | $9.72 | $11.44 | $11.44 | $10.42 | $11.44 | $11.44 | $9.72 | $9.72 | $9.72 | $11.44 | $11.44 | ||
| A4257 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | $12.75 | ||
| A4258 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | $18.05 | ||
| A4259 | $12.06 | $10.83 | $10.83 | $10.83 | $10.83 | $10.83 | $10.83 | $12.06 | $12.06 | $10.83 | $10.83 | $10.83 | ||
| A4265 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | $3.39 | ||
| A4556 | $12.14 | $10.32 | $12.14 | $10.32 | $12.14 | $10.32 | $10.32 | $12.14 | $12.14 | $10.32 | $12.14 | $10.32 | ||
| A4557 | $21.10 | $17.94 | $17.94 | $21.10 | $21.10 | $21.10 | $21.10 | $17.94 | $19.07 | $17.94 | $21.10 | $21.10 | ||
| A4558 | $5.45 | $4.63 | $4.63 | $4.63 | $4.63 | $4.63 | $4.63 | $5.45 | $4.63 | $4.63 | $5.45 | $4.63 | ||
| A4559 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | $0.10 | ||
| A4595 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | $28.81 | ||
| A4615 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | $0.83 | ||
| A4616 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | $0.08 | ||
| A4617 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | $3.59 | ||
| A4620 | $0.69 | $0.72 | $0.69 | $0.69 | $0.69 | $0.69 | $0.69 | $0.69 | $0.69 | $0.69 | $0.69 | $0.69 | ||
| A6550 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | $27.42 | ||
| A7018 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | $0.38 | ||
| E1701 | $9.02 | $10.37 | $10.37 | $10.37 | $9.02 | $10.37 | $10.37 | $10.37 | $10.61 | $10.37 | $10.37 | $10.37 | ||
| E1702 | $19.18 | $20.81 | $20.81 | $22.57 | $19.18 | $22.57 | $22.57 | $20.81 | $22.57 | $20.81 | $22.57 | $22.57 | ||
| K0552 | $2.65 | $2.61 | $2.65 | $2.65 | $2.61 | $2.65 | $2.65 | $2.65 | $2.65 | $2.65 | $2.65 | $2.65 | ||
| K0609 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | $806.09 | ||
| K0609 | KF | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | $871.43 | |