Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for L3677. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
$29/mo after the trial. Cancel anytime.
Publishing states
10
Median % of Medicare
--
Rate range
$13.08 - $887.60
L3677 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Florida | $155.05 | -- | -- | 2026 |
| Hawaii | $13.08 | -- | -- | 2025 |
| Kansas | $110.50 | -- | -- | 2006 |
| Maine | $887.60 | -- | -- | 2026 |
| Michigan | $168.60 | -- | -- | 2026 |
| North Carolina | $189.44 | -- | -- | 2025 |
| Nevada | $67.87 | -- | -- | -- |
| Texas | $62.50* | -- | -- | 2021 |
| Virginia | $264.73 | -- | -- | 2023 |
| Wisconsin | $111.88 | -- | -- | 2008 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related dme & supplies codes
- A2001 - Innovamatrix ac, per square centimeter (add-on, list separately in addition to primary procedure)
- A2002 - Mirragen advanced wound matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2005 - Microlyte matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2006 - Novosorb synpath dermal matrix, per square centimeter (add-on, list separately in addition to primary procedure)
- A2007 - Restrata, per square centimeter (add-on, list separately in addition to primary procedure)
- A2008 - Theragenesis, per square centimeter (add-on, list separately in addition to primary procedure)
- A2009 - Symphony, per square centimeter (add-on, list separately in addition to primary procedure)
- A2010 - Apis, per square centimeter (add-on, list separately in addition to primary procedure)
All 150 codes from L3000 to L3995 or every dme & supplies code by number.
Frequently asked questions
How much does Medicaid pay for L3677?
10 state Medicaid programs publish a fee-for-service rate for L3677 (shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise), ranging from $13.08 in Hawaii to $887.60 in Maine. The full table on this page lists every publishing state's current rate.
Which state pays the most for L3677?
Maine publishes the highest Medicaid rate for L3677 at $887.60. Hawaii publishes the lowest at $13.08.
Does L3677 require prior authorization under Medicaid?
No publishing state flags L3677 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.