K0041 — Large size footplate, each
HCPCS Level II K-code · short descriptor: “Large size footplate each”
- Code system
- HCPCS Level II
- Family
- K — DME MAC temporary codes
- Medicare coverage status
- Carrier judgment — coverage decided by the DME MAC
- DMEPOS payment category
- Inexpensive or routinely purchased
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 2
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
K0041 Medicare fee schedule (October 2026)
NU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $60.51 to $69.27 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $62.23 | — |
| AL | $60.51 | $62.75 |
| AR | $60.51 | $62.75 |
| AZ | $60.51 | $62.23 |
| CA | $60.51 | $62.23 |
| CO | $60.51 | $62.75 |
| CT | $60.51 | $62.75 |
| DC | $60.51 | $62.75 |
| DE | $60.51 | $62.75 |
| FL | $60.51 | $62.75 |
| GA | $60.51 | $62.75 |
| HI | $62.23 | — |
| IA | $60.51 | $62.23 |
| ID | $60.51 | $62.23 |
| IL | $60.51 | $62.75 |
| IN | $60.51 | $62.75 |
| KS | $60.51 | $62.23 |
| KY | $60.51 | $62.75 |
| LA | $60.51 | $62.75 |
| MA | $60.51 | $62.75 |
| MD | $60.51 | $62.75 |
| ME | $60.51 | $62.75 |
| MI | $60.51 | $62.75 |
| MN | $60.51 | $62.75 |
| MO | $60.51 | $62.75 |
| MS | $60.51 | $62.75 |
| MT | $60.51 | $62.23 |
| NC | $60.51 | $62.75 |
| ND | $60.51 | $62.23 |
| NE | $60.51 | $62.23 |
| NH | $60.51 | $62.75 |
| NJ | $60.51 | $62.75 |
| NM | $60.51 | $62.75 |
| NV | $60.51 | $62.23 |
| NY | $60.51 | $62.75 |
| OH | $60.51 | $62.75 |
| OK | $60.51 | $62.75 |
| OR | $60.51 | $62.23 |
| PA | $60.51 | $62.75 |
| PR | $69.27 | — |
| RI | $60.51 | $62.75 |
| SC | $60.51 | $62.75 |
| SD | $60.51 | $62.23 |
| TN | $60.51 | $62.75 |
| TX | $60.51 | $62.75 |
| UT | $60.51 | $62.75 |
| VA | $60.51 | $62.75 |
| VI | $62.75 | — |
| VT | $60.51 | $62.75 |
| WA | $60.51 | $62.75 |
| WI | $60.51 | $62.75 |
| WV | $60.51 | $62.75 |
| WY | $60.51 | $62.23 |
NU + KE — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $66.87 to $74.92 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $66.87 | — |
| AL | — | $67.46 |
| AR | — | $67.46 |
| AZ | — | $66.87 |
| CA | — | $66.87 |
| CO | — | $67.46 |
| CT | — | $67.46 |
| DC | — | $67.46 |
| DE | — | $67.46 |
| FL | — | $67.46 |
| GA | — | $67.46 |
| HI | $66.87 | — |
| IA | — | $66.87 |
| ID | — | $66.87 |
| IL | — | $67.46 |
| IN | — | $67.46 |
| KS | — | $66.87 |
| KY | — | $67.46 |
| LA | — | $67.46 |
| MA | — | $67.46 |
| MD | — | $67.46 |
| ME | — | $67.46 |
| MI | — | $67.46 |
| MN | — | $67.46 |
| MO | — | $67.46 |
| MS | — | $67.46 |
| MT | — | $66.87 |
| NC | — | $67.46 |
| ND | — | $66.87 |
| NE | — | $66.87 |
| NH | — | $67.46 |
| NJ | — | $67.46 |
| NM | — | $67.46 |
| NV | — | $66.87 |
| NY | — | $67.46 |
| OH | — | $67.46 |
| OK | — | $67.46 |
| OR | — | $66.87 |
| PA | — | $67.46 |
| PR | $74.92 | — |
| RI | — | $67.46 |
| SC | — | $67.46 |
| SD | — | $66.87 |
| TN | — | $67.46 |
| TX | — | $67.46 |
| UT | — | $67.46 |
| VA | — | $67.46 |
| VI | $67.46 | — |
| VT | — | $67.46 |
| WA | — | $67.46 |
| WI | — | $67.46 |
| WV | — | $67.46 |
| WY | — | $66.87 |
NU + KU — New purchase Inexpensive or routinely purchased
Medicare allowable ranges from $63.95 to $78.03 depending on state and rural status.
Former-CBA payment limits: ceiling $64.99 · floor $55.24
| State | Non-rural | Rural |
|---|---|---|
| AK | $63.95 | — |
| AL | $64.99 | — |
| AR | $64.99 | — |
| AZ | $63.95 | — |
| CA | $63.95 | — |
| CO | $64.99 | — |
| CT | $64.99 | — |
| DC | $64.99 | — |
| DE | $64.99 | — |
| FL | $64.99 | — |
| GA | $64.99 | — |
| HI | $63.95 | — |
| IA | $63.95 | — |
| ID | $63.95 | — |
| IL | $64.99 | — |
| IN | $64.99 | — |
| KS | $63.95 | — |
| KY | $64.99 | — |
| LA | $64.99 | — |
| MA | $64.99 | — |
| MD | $64.99 | — |
| ME | $64.99 | — |
| MI | $64.99 | — |
| MN | $64.99 | — |
| MO | $64.99 | — |
| MS | $64.99 | — |
| MT | $63.95 | — |
| NC | $64.99 | — |
| ND | $63.95 | — |
| NE | $63.95 | — |
| NH | $64.99 | — |
| NJ | $64.99 | — |
| NM | $64.99 | — |
| NV | $63.95 | — |
| NY | $64.99 | — |
| OH | $64.99 | — |
| OK | $64.99 | — |
| OR | $63.95 | — |
| PA | $64.99 | — |
| PR | $78.03 | — |
| RI | $64.99 | — |
| SC | $64.99 | — |
| SD | $63.95 | — |
| TN | $64.99 | — |
| TX | $64.99 | — |
| UT | $64.99 | — |
| VA | $64.99 | — |
| VI | $64.99 | — |
| VT | $64.99 | — |
| WA | $64.99 | — |
| WI | $64.99 | — |
| WV | $64.99 | — |
| WY | $63.95 | — |
RR — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $6.05 to $6.92 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $6.22 | — |
| AL | $6.05 | $6.30 |
| AR | $6.05 | $6.30 |
| AZ | $6.05 | $6.22 |
| CA | $6.05 | $6.22 |
| CO | $6.05 | $6.30 |
| CT | $6.05 | $6.30 |
| DC | $6.05 | $6.30 |
| DE | $6.05 | $6.30 |
| FL | $6.05 | $6.30 |
| GA | $6.05 | $6.30 |
| HI | $6.22 | — |
| IA | $6.05 | $6.22 |
| ID | $6.05 | $6.22 |
| IL | $6.05 | $6.30 |
| IN | $6.05 | $6.30 |
| KS | $6.05 | $6.22 |
| KY | $6.05 | $6.30 |
| LA | $6.05 | $6.30 |
| MA | $6.05 | $6.30 |
| MD | $6.05 | $6.30 |
| ME | $6.05 | $6.30 |
| MI | $6.05 | $6.30 |
| MN | $6.05 | $6.30 |
| MO | $6.05 | $6.30 |
| MS | $6.05 | $6.30 |
| MT | $6.05 | $6.22 |
| NC | $6.05 | $6.30 |
| ND | $6.05 | $6.22 |
| NE | $6.05 | $6.22 |
| NH | $6.05 | $6.30 |
| NJ | $6.05 | $6.30 |
| NM | $6.05 | $6.30 |
| NV | $6.05 | $6.22 |
| NY | $6.05 | $6.30 |
| OH | $6.05 | $6.30 |
| OK | $6.05 | $6.30 |
| OR | $6.05 | $6.22 |
| PA | $6.05 | $6.30 |
| PR | $6.92 | — |
| RI | $6.05 | $6.30 |
| SC | $6.05 | $6.30 |
| SD | $6.05 | $6.22 |
| TN | $6.05 | $6.30 |
| TX | $6.05 | $6.30 |
| UT | $6.05 | $6.30 |
| VA | $6.05 | $6.30 |
| VI | $6.30 | — |
| VT | $6.05 | $6.30 |
| WA | $6.05 | $6.30 |
| WI | $6.05 | $6.30 |
| WV | $6.05 | $6.30 |
| WY | $6.05 | $6.22 |
RR + KE — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $6.68 to $7.49 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $6.68 | — |
| AL | — | $6.78 |
| AR | — | $6.78 |
| AZ | — | $6.68 |
| CA | — | $6.68 |
| CO | — | $6.78 |
| CT | — | $6.78 |
| DC | — | $6.78 |
| DE | — | $6.78 |
| FL | — | $6.78 |
| GA | — | $6.78 |
| HI | $6.68 | — |
| IA | — | $6.68 |
| ID | — | $6.68 |
| IL | — | $6.78 |
| IN | — | $6.78 |
| KS | — | $6.68 |
| KY | — | $6.78 |
| LA | — | $6.78 |
| MA | — | $6.78 |
| MD | — | $6.78 |
| ME | — | $6.78 |
| MI | — | $6.78 |
| MN | — | $6.78 |
| MO | — | $6.78 |
| MS | — | $6.78 |
| MT | — | $6.68 |
| NC | — | $6.78 |
| ND | — | $6.68 |
| NE | — | $6.68 |
| NH | — | $6.78 |
| NJ | — | $6.78 |
| NM | — | $6.78 |
| NV | — | $6.68 |
| NY | — | $6.78 |
| OH | — | $6.78 |
| OK | — | $6.78 |
| OR | — | $6.68 |
| PA | — | $6.78 |
| PR | $7.49 | — |
| RI | — | $6.78 |
| SC | — | $6.78 |
| SD | — | $6.68 |
| TN | — | $6.78 |
| TX | — | $6.78 |
| UT | — | $6.78 |
| VA | — | $6.78 |
| VI | $6.78 | — |
| VT | — | $6.78 |
| WA | — | $6.78 |
| WI | — | $6.78 |
| WV | — | $6.78 |
| WY | — | $6.68 |
RR + KU — Monthly rental Inexpensive or routinely purchased
Medicare allowable ranges from $6.39 to $7.79 depending on state and rural status.
Former-CBA payment limits: ceiling $6.56 · floor $5.58
| State | Non-rural | Rural |
|---|---|---|
| AK | $6.39 | — |
| AL | $6.56 | — |
| AR | $6.56 | — |
| AZ | $6.39 | — |
| CA | $6.39 | — |
| CO | $6.56 | — |
| CT | $6.56 | — |
| DC | $6.56 | — |
| DE | $6.56 | — |
| FL | $6.56 | — |
| GA | $6.56 | — |
| HI | $6.39 | — |
| IA | $6.39 | — |
| ID | $6.39 | — |
| IL | $6.56 | — |
| IN | $6.56 | — |
| KS | $6.39 | — |
| KY | $6.56 | — |
| LA | $6.56 | — |
| MA | $6.56 | — |
| MD | $6.56 | — |
| ME | $6.56 | — |
| MI | $6.56 | — |
| MN | $6.56 | — |
| MO | $6.56 | — |
| MS | $6.56 | — |
| MT | $6.39 | — |
| NC | $6.56 | — |
| ND | $6.39 | — |
| NE | $6.39 | — |
| NH | $6.56 | — |
| NJ | $6.56 | — |
| NM | $6.56 | — |
| NV | $6.39 | — |
| NY | $6.56 | — |
| OH | $6.56 | — |
| OK | $6.56 | — |
| OR | $6.39 | — |
| PA | $6.56 | — |
| PR | $7.79 | — |
| RI | $6.56 | — |
| SC | $6.56 | — |
| SD | $6.39 | — |
| TN | $6.56 | — |
| TX | $6.56 | — |
| UT | $6.56 | — |
| VA | $6.56 | — |
| VI | $6.56 | — |
| VT | $6.56 | — |
| WA | $6.56 | — |
| WI | $6.56 | — |
| WV | $6.56 | — |
| WY | $6.39 | — |
UE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $45.38 to $51.95 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $46.65 | — |
| AL | $45.38 | $47.06 |
| AR | $45.38 | $47.06 |
| AZ | $45.38 | $46.65 |
| CA | $45.38 | $46.65 |
| CO | $45.38 | $47.06 |
| CT | $45.38 | $47.06 |
| DC | $45.38 | $47.06 |
| DE | $45.38 | $47.06 |
| FL | $45.38 | $47.06 |
| GA | $45.38 | $47.06 |
| HI | $46.65 | — |
| IA | $45.38 | $46.65 |
| ID | $45.38 | $46.65 |
| IL | $45.38 | $47.06 |
| IN | $45.38 | $47.06 |
| KS | $45.38 | $46.65 |
| KY | $45.38 | $47.06 |
| LA | $45.38 | $47.06 |
| MA | $45.38 | $47.06 |
| MD | $45.38 | $47.06 |
| ME | $45.38 | $47.06 |
| MI | $45.38 | $47.06 |
| MN | $45.38 | $47.06 |
| MO | $45.38 | $47.06 |
| MS | $45.38 | $47.06 |
| MT | $45.38 | $46.66 |
| NC | $45.38 | $47.06 |
| ND | $45.38 | $46.65 |
| NE | $45.38 | $46.65 |
| NH | $45.38 | $47.06 |
| NJ | $45.38 | $47.06 |
| NM | $45.38 | $47.06 |
| NV | $45.38 | $46.65 |
| NY | $45.38 | $47.06 |
| OH | $45.38 | $47.06 |
| OK | $45.38 | $47.06 |
| OR | $45.38 | $46.65 |
| PA | $45.38 | $47.06 |
| PR | $51.95 | — |
| RI | $45.38 | $47.06 |
| SC | $45.38 | $47.06 |
| SD | $45.38 | $46.65 |
| TN | $45.38 | $47.06 |
| TX | $45.38 | $47.06 |
| UT | $45.38 | $47.06 |
| VA | $45.38 | $47.06 |
| VI | $47.06 | — |
| VT | $45.38 | $47.06 |
| WA | $45.38 | $47.06 |
| WI | $45.38 | $47.06 |
| WV | $45.38 | $47.06 |
| WY | $45.38 | $46.65 |
UE + KE — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $50.12 to $56.19 depending on state and rural status.
| State | Non-rural | Rural |
|---|---|---|
| AK | $50.12 | — |
| AL | — | $50.59 |
| AR | — | $50.59 |
| AZ | — | $50.12 |
| CA | — | $50.12 |
| CO | — | $50.59 |
| CT | — | $50.59 |
| DC | — | $50.59 |
| DE | — | $50.59 |
| FL | — | $50.59 |
| GA | — | $50.59 |
| HI | $50.12 | — |
| IA | — | $50.12 |
| ID | — | $50.12 |
| IL | — | $50.59 |
| IN | — | $50.59 |
| KS | — | $50.12 |
| KY | — | $50.59 |
| LA | — | $50.59 |
| MA | — | $50.59 |
| MD | — | $50.59 |
| ME | — | $50.59 |
| MI | — | $50.59 |
| MN | — | $50.59 |
| MO | — | $50.59 |
| MS | — | $50.59 |
| MT | — | $50.14 |
| NC | — | $50.59 |
| ND | — | $50.12 |
| NE | — | $50.12 |
| NH | — | $50.59 |
| NJ | — | $50.59 |
| NM | — | $50.59 |
| NV | — | $50.12 |
| NY | — | $50.59 |
| OH | — | $50.59 |
| OK | — | $50.59 |
| OR | — | $50.12 |
| PA | — | $50.59 |
| PR | $56.19 | — |
| RI | — | $50.59 |
| SC | — | $50.59 |
| SD | — | $50.12 |
| TN | — | $50.59 |
| TX | — | $50.59 |
| UT | — | $50.59 |
| VA | — | $50.59 |
| VI | $50.59 | — |
| VT | — | $50.59 |
| WA | — | $50.59 |
| WI | — | $50.59 |
| WV | — | $50.59 |
| WY | — | $50.12 |
UE + KU — Used purchase Inexpensive or routinely purchased
Medicare allowable ranges from $47.92 to $58.52 depending on state and rural status.
Former-CBA payment limits: ceiling $48.74 · floor $41.43
| State | Non-rural | Rural |
|---|---|---|
| AK | $47.92 | — |
| AL | $48.74 | — |
| AR | $48.74 | — |
| AZ | $47.92 | — |
| CA | $47.92 | — |
| CO | $48.74 | — |
| CT | $48.74 | — |
| DC | $48.74 | — |
| DE | $48.74 | — |
| FL | $48.74 | — |
| GA | $48.74 | — |
| HI | $47.92 | — |
| IA | $47.92 | — |
| ID | $47.92 | — |
| IL | $48.74 | — |
| IN | $48.74 | — |
| KS | $47.92 | — |
| KY | $48.74 | — |
| LA | $48.74 | — |
| MA | $48.74 | — |
| MD | $48.74 | — |
| ME | $48.74 | — |
| MI | $48.74 | — |
| MN | $48.74 | — |
| MO | $48.74 | — |
| MS | $48.74 | — |
| MT | $47.94 | — |
| NC | $48.74 | — |
| ND | $47.92 | — |
| NE | $47.92 | — |
| NH | $48.74 | — |
| NJ | $48.74 | — |
| NM | $48.74 | — |
| NV | $47.92 | — |
| NY | $48.74 | — |
| OH | $48.74 | — |
| OK | $48.74 | — |
| OR | $47.92 | — |
| PA | $48.74 | — |
| PR | $58.52 | — |
| RI | $48.74 | — |
| SC | $48.74 | — |
| SD | $47.92 | — |
| TN | $48.74 | — |
| TX | $48.74 | — |
| UT | $48.74 | — |
| VA | $48.74 | — |
| VI | $48.74 | — |
| VT | $48.74 | — |
| WA | $48.74 | — |
| WI | $48.74 | — |
| WV | $48.74 | — |
| WY | $47.92 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps K0041 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Anatomic Consideration.
Common denial codes to watch
Related K-codes
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