MyMedi-AI

K0042 — Standard size footplate, replacement only, each

HCPCS Level II K-code · short descriptor: “Standard size ftplate rep ea”

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.

K0042 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $33.28 to $61.80 depending on state and rural status.

StateNon-ruralRural
AK$33.28—
AL$38.04$38.04
AR$38.86$39.89
AZ$38.04$38.04
CA$38.04$38.04
CO$38.86$41.81
CT$38.86$41.81
DC$38.86$41.81
DE$38.86$41.81
FL$38.86$41.81
GA$38.86$41.81
HI$33.28—
IA$38.04$38.04
ID$38.04$38.04
IL$38.86$41.81
IN$38.86$41.81
KS$38.04$38.04
KY$38.86$40.06
LA$38.86$40.47
MA$38.86$41.81
MD$38.86$41.81
ME$38.86$41.81
MI$38.86$39.55
MN$38.86$41.81
MO$38.04$38.04
MS$38.04$38.04
MT$38.04$38.04
NC$38.04$38.04
ND$38.04$38.04
NE$38.04$38.04
NH$38.86$41.81
NJ$38.86$41.81
NM$38.86$41.81
NV$38.04$38.04
NY$38.86$41.81
OH$38.86$40.70
OK$38.86$41.81
OR$38.04$38.04
PA$38.86$41.81
PR$61.80—
RI$38.86$41.81
SC$38.86$41.81
SD$38.04$38.04
TN$38.86$41.81
TX$38.86$41.81
UT$38.04$38.04
VA$38.86$41.80
VI$41.81—
VT$38.86$41.81
WA$38.04$38.04
WI$38.86$41.81
WV$38.86$41.81
WY$38.04$38.04

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $38.11 to $67.94 depending on state and rural status.

StateNon-ruralRural
AK$38.11—
AL—$41.04
AR—$42.86
AZ—$41.04
CA—$41.04
CO—$45.05
CT—$45.05
DC—$45.05
DE—$45.05
FL—$45.05
GA—$45.05
HI$38.11—
IA—$41.04
ID—$41.04
IL—$45.05
IN—$45.05
KS—$41.04
KY—$43.05
LA—$43.52
MA—$45.05
MD—$45.05
ME—$45.05
MI—$42.47
MN—$45.05
MO—$41.04
MS—$41.04
MT—$41.04
NC—$41.04
ND—$41.04
NE—$41.04
NH—$45.05
NJ—$45.05
NM—$45.05
NV—$41.04
NY—$45.05
OH—$43.79
OK—$45.05
OR—$41.04
PA—$45.05
PR$67.94—
RI—$45.05
SC—$45.05
SD—$41.04
TN—$45.05
TX—$45.05
UT—$41.04
VA—$45.04
VI$45.05—
VT—$45.05
WA—$41.04
WI—$45.05
WV—$45.05
WY—$41.04

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $33.28 to $84.76 depending on state and rural status.

Former-CBA payment limits: ceiling $44.75 · floor $38.04

StateNon-ruralRural
AK$33.28—
AL$38.04—
AR$40.91—
AZ$38.04—
CA$38.04—
CO$44.75—
CT$44.75—
DC$44.75—
DE$44.75—
FL$44.75—
GA$44.75—
HI$33.28—
IA$38.04—
ID$38.04—
IL$44.75—
IN$44.75—
KS$38.04—
KY$41.25—
LA$42.08—
MA$44.75—
MD$44.75—
ME$44.75—
MI$40.25—
MN$44.75—
MO$38.04—
MS$38.04—
MT$38.04—
NC$38.04—
ND$38.04—
NE$38.04—
NH$44.75—
NJ$44.75—
NM$44.75—
NV$38.04—
NY$44.75—
OH$42.55—
OK$44.75—
OR$38.04—
PA$44.75—
PR$84.76—
RI$44.75—
SC$44.75—
SD$38.04—
TN$44.75—
TX$44.75—
UT$38.04—
VA$44.72—
VI$44.75—
VT$44.75—
WA$38.04—
WI$44.75—
WV$44.75—
WY$38.04—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.35 to $7.23 depending on state and rural status.

StateNon-ruralRural
AK$3.35—
AL$3.80$3.80
AR$3.89$4.00
AZ$3.80$3.80
CA$3.80$3.80
CO$3.89$4.18
CT$3.89$4.18
DC$3.89$4.18
DE$3.89$4.18
FL$3.89$4.18
GA$3.89$4.18
HI$3.35—
IA$3.80$3.80
ID$3.80$3.80
IL$3.89$4.18
IN$3.89$4.18
KS$3.80$3.80
KY$3.89$4.02
LA$3.89$4.06
MA$3.89$4.18
MD$3.89$4.18
ME$3.89$4.18
MI$3.89$3.95
MN$3.89$4.18
MO$3.80$3.80
MS$3.80$3.80
MT$3.80$3.80
NC$3.80$3.80
ND$3.80$3.80
NE$3.80$3.80
NH$3.89$4.18
NJ$3.89$4.18
NM$3.89$4.18
NV$3.80$3.80
NY$3.89$4.18
OH$3.89$4.08
OK$3.89$4.18
OR$3.80$3.80
PA$3.89$4.18
PR$7.23—
RI$3.89$4.18
SC$3.89$4.18
SD$3.80$3.80
TN$3.89$4.18
TX$3.89$4.18
UT$3.80$3.80
VA$3.89$4.18
VI$4.18—
VT$3.89$4.18
WA$3.80$3.80
WI$3.89$4.18
WV$3.89$4.18
WY$3.80$3.80

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.84 to $7.99 depending on state and rural status.

StateNon-ruralRural
AK$3.84—
AL—$4.10
AR—$4.30
AZ—$4.10
CA—$4.10
CO—$4.50
CT—$4.50
DC—$4.50
DE—$4.50
FL—$4.50
GA—$4.50
HI$3.84—
IA—$4.10
ID—$4.10
IL—$4.50
IN—$4.50
KS—$4.10
KY—$4.33
LA—$4.36
MA—$4.50
MD—$4.50
ME—$4.50
MI—$4.24
MN—$4.50
MO—$4.10
MS—$4.10
MT—$4.10
NC—$4.10
ND—$4.10
NE—$4.10
NH—$4.50
NJ—$4.50
NM—$4.50
NV—$4.10
NY—$4.50
OH—$4.39
OK—$4.50
OR—$4.10
PA—$4.50
PR$7.99—
RI—$4.50
SC—$4.50
SD—$4.10
TN—$4.50
TX—$4.50
UT—$4.10
VA—$4.50
VI$4.50—
VT—$4.50
WA—$4.10
WI—$4.50
WV—$4.50
WY—$4.10

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $3.36 to $10.58 depending on state and rural status.

Former-CBA payment limits: ceiling $4.47 · floor $3.80

StateNon-ruralRural
AK$3.36—
AL$3.80—
AR$4.12—
AZ$3.80—
CA$3.80—
CO$4.47—
CT$4.47—
DC$4.47—
DE$4.47—
FL$4.47—
GA$4.47—
HI$3.36—
IA$3.80—
ID$3.80—
IL$4.47—
IN$4.47—
KS$3.80—
KY$4.17—
LA$4.24—
MA$4.47—
MD$4.47—
ME$4.47—
MI$4.02—
MN$4.47—
MO$3.80—
MS$3.80—
MT$3.80—
NC$3.80—
ND$3.80—
NE$3.80—
NH$4.47—
NJ$4.47—
NM$4.47—
NV$3.80—
NY$4.47—
OH$4.28—
OK$4.47—
OR$3.80—
PA$4.47—
PR$10.58—
RI$4.47—
SC$4.47—
SD$3.80—
TN$4.47—
TX$4.47—
UT$3.80—
VA$4.47—
VI$4.47—
VT$4.47—
WA$3.80—
WI$4.47—
WV$4.47—
WY$3.80—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $24.97 to $46.34 depending on state and rural status.

StateNon-ruralRural
AK$24.97—
AL$28.52$28.52
AR$29.15$29.93
AZ$28.52$28.52
CA$28.52$28.52
CO$29.15$31.35
CT$29.15$31.35
DC$29.15$31.35
DE$29.15$31.35
FL$29.15$31.35
GA$29.15$31.35
HI$24.97—
IA$28.52$28.52
ID$28.52$28.52
IL$29.15$31.35
IN$29.15$31.35
KS$28.52$28.52
KY$29.15$30.05
LA$29.15$30.36
MA$29.15$31.35
MD$29.15$31.35
ME$29.15$31.35
MI$29.15$29.67
MN$29.15$31.35
MO$28.52$28.52
MS$28.52$28.52
MT$28.52$28.52
NC$28.52$28.52
ND$28.52$28.52
NE$28.52$28.52
NH$29.15$31.35
NJ$29.15$31.35
NM$29.15$31.35
NV$28.52$28.52
NY$29.15$31.35
OH$29.15$30.53
OK$29.15$31.35
OR$28.52$28.52
PA$29.15$31.35
PR$46.34—
RI$29.15$31.35
SC$29.15$31.35
SD$28.52$28.52
TN$29.15$31.35
TX$29.15$31.35
UT$28.52$28.52
VA$29.15$31.35
VI$31.35—
VT$29.15$31.35
WA$28.52$28.52
WI$29.15$31.35
WV$29.15$31.35
WY$28.52$28.52

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $28.59 to $50.94 depending on state and rural status.

StateNon-ruralRural
AK$28.59—
AL—$30.77
AR—$32.16
AZ—$30.77
CA—$30.77
CO—$33.78
CT—$33.78
DC—$33.78
DE—$33.78
FL—$33.78
GA—$33.78
HI$28.59—
IA—$30.77
ID—$30.77
IL—$33.78
IN—$33.78
KS—$30.77
KY—$32.29
LA—$32.65
MA—$33.78
MD—$33.78
ME—$33.78
MI—$31.86
MN—$33.78
MO—$30.77
MS—$30.77
MT—$30.77
NC—$30.77
ND—$30.77
NE—$30.77
NH—$33.78
NJ—$33.78
NM—$33.78
NV—$30.77
NY—$33.78
OH—$32.85
OK—$33.78
OR—$30.77
PA—$33.78
PR$50.94—
RI—$33.78
SC—$33.78
SD—$30.77
TN—$33.78
TX—$33.78
UT—$30.77
VA—$33.78
VI$33.78—
VT—$33.78
WA—$30.77
WI—$33.78
WV—$33.78
WY—$30.77

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $24.96 to $63.52 depending on state and rural status.

Former-CBA payment limits: ceiling $33.55 · floor $28.52

StateNon-ruralRural
AK$24.96—
AL$28.52—
AR$30.70—
AZ$28.52—
CA$28.52—
CO$33.55—
CT$33.55—
DC$33.55—
DE$33.55—
FL$33.55—
GA$33.55—
HI$24.96—
IA$28.52—
ID$28.52—
IL$33.55—
IN$33.55—
KS$28.52—
KY$30.95—
LA$31.57—
MA$33.55—
MD$33.55—
ME$33.55—
MI$30.19—
MN$33.55—
MO$28.52—
MS$28.52—
MT$28.52—
NC$28.52—
ND$28.52—
NE$28.52—
NH$33.55—
NJ$33.55—
NM$33.55—
NV$28.52—
NY$33.55—
OH$31.90—
OK$33.55—
OR$28.52—
PA$33.55—
PR$63.52—
RI$33.55—
SC$33.55—
SD$28.52—
TN$33.55—
TX$33.55—
UT$28.52—
VA$33.55—
VI$33.55—
VT$33.55—
WA$28.52—
WI$33.55—
WV$33.55—
WY$28.52—
Amounts are the Medicare DMEPOS fee-schedule allowables effective October 2026 (CMS DMEPOS Fee Schedule October 2026 (DME26-D)). Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Unit limit (MUE)

Medicare's Medically Unlikely Edit caps K0042 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

CO-50 medical necessityCO-151 frequency/units

Related K-codes

K0001K0002K0003K0004K0005K0006K0007K0008K0009K0010K0011K0012

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