| Jurisdiction A DME MAC | ||||||||||||||
| 2008 DMEPOS/PEN Fee Schedule Updates | ||||||||||||||
| Inclusion of a fee schedule amount for an item does not necessarily indicate coverage | ||||||||||||||
| Parenteral and Enteral Fees | ||||||||||||||
| HCPCS | Mod1 | Mod2 | CT | DC | DE | MA | MD | ME | NH | NJ | NY | PA | RI | VT |
| B4034 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | $6.55 | ||
| B4035 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | $12.49 | ||
| B4036 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | $8.57 | ||
| B4081 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | $23.16 | ||
| B4082 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | $17.23 | ||
| B4083 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | $2.64 | ||
| B4087 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | ||
| B4088 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | $38.22 | ||
| B4149 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | $1.68 | ||
| B4150 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | $0.72 | ||
| B4152 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | $0.60 | ||
| B4153 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | $2.04 | ||
| B4154 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | $1.30 | ||
| B4155 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | $1.02 | ||
| B4164 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | $17.65 | ||
| B4168 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | $25.72 | ||
| B4176 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | $49.77 | ||
| B4178 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | $59.75 | ||
| B4180 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | $25.32 | ||
| B4185 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | $11.67 | ||
| B4189 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | $184.57 | ||
| B4193 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | $238.51 | ||
| B4197 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | $290.37 | ||
| B4199 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | $331.81 | ||
| B4216 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | $8.02 | ||
| B4220 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | $8.31 | ||
| B4222 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | $10.25 | ||
| B4224 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | $25.97 | ||
| B5000 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | $12.34 | ||
| B5100 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | $4.83 | ||
| B9000 | NU | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | |
| B9000 | RR | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | $120.70 | |
| B9000 | UE | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | |
| B9002 | NU | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | $1,313.52 | |
| B9002 | RR | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | $127.22 | |
| B9002 | UE | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | $985.14 | |
| B9004 | NU | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | |
| B9004 | RR | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | |
| B9004 | UE | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | |
| B9006 | NU | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | $2,620.10 | |
| B9006 | RR | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | $414.78 | |
| B9006 | UE | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | $1,965.07 | |
| E0776 | NU | BA | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 | $109.24 |
| E0776 | RR | BA | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 | $27.65 |
| E0776 | UE | BA | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 | $81.93 |