L6697 Medicaid Rate by State

Addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)

35 state Medicaid programs publish a fee-for-service rate for L6697 (addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)), ranging from $621.35 in Hawaii to $1,640.77 in Montana, with a median of 78.5% of the national Medicare amount.

Every state, kept current

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This page shows one representative rate per state for L6697. Full schedules include every locality, modifier, and age-band variant.

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Publishing states

35

Median % of Medicare

78.5%

Rate range

$621.35 - $1,640.77

L6697 rates in every publishing state

StateMedicaid rate% of MedicarePrior authVintage
Arkansas$1,258.08*78%--2026
Arizona$1,472.4191.3%--2026
California$828.4751.4%--2026
Colorado$1,295.7980.4%Required2026
Connecticut$940.5358.3%Required2013
District of Columbia$1,264.7278.5%Required2026
Hawaii$621.3538.5%--2025
Idaho$1,365.9084.7%Not required2026
Illinois$1,316.2081.6%--2026
Indiana$1,587.9898.5%--2026
Kansas$1,289.3980%--2026
Kentucky$960.1159.6%--2026
Massachusetts$1,386.7086%--2026
Maryland$1,343.7783.4%Required2026
Maine$1,580.9098.1%--2026
Michigan$1,198.6174.4%--2026
Minnesota$1,619.74100.5%Conditional2026
Missouri$1,165.12*72.3%Required2019
Mississippi$1,302.81*80.8%--2026
Montana$1,640.77101.8%Not required2026
North Carolina$1,057.1665.6%--2025
Nebraska$1,383.8985.8%--2026
New Jersey$1,106.6368.6%Not required2026
New Mexico$1,596.4199%--2025
Nevada$1,226.3376.1%--2017
Ohio$1,239.9276.9%--2026
Oklahoma$1,139.8470.7%--2026
South Carolina$1,315.6881.6%--2024
Texas$1,199.72*74.4%--2010
Utah$1,174.22*72.8%Not required2026
Virginia$1,191.5173.9%--2012
Vermont$1,325.1682.2%--2026
Washington$1,188.1673.7%--2026
West Virginia$1,264.7278.5%--2026
Wyoming$1,010.2762.7%--2021

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

All 126 codes from L6000 to L6975 or every dme & supplies code by number.

Frequently asked questions

How much does Medicaid pay for L6697?

35 state Medicaid programs publish a fee-for-service rate for L6697 (addition to upper extremity prosthesis, below elbow/above elbow, custom fabricated socket insert for other than congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l6694 or l6695)), ranging from $621.35 in Hawaii to $1,640.77 in Montana, with a median of 78.5% of the national Medicare amount. The full table on this page lists every publishing state's current rate.

Which state pays the most for L6697?

Montana publishes the highest Medicaid rate for L6697 at $1,640.77 (101.8% of the national Medicare amount). Hawaii publishes the lowest at $621.35.

Does L6697 require prior authorization under Medicaid?

6 of the 35 publishing states flag L6697 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".