MyMedi-AI

K0053 — Elevating footrests, articulating (telescoping), each

HCPCS Level II K-code · short descriptor: “Elevate footrest articulate”

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.

K0053 Medicare fee schedule (October 2026)

NU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $98.38 to $131.84 depending on state and rural status.

StateNon-ruralRural
AK$118.27—
AL$102.36$119.31
AR$102.36$119.31
AZ$101.54$118.27
CA$98.38$118.27
CO$104.17$119.31
CT$108.06$119.31
DC$102.47$119.31
DE$102.47$119.31
FL$102.36$119.31
GA$102.36$119.31
HI$118.27—
IA$101.28$118.27
ID$104.17$118.27
IL$105.42$119.31
IN$105.42$119.31
KS$101.28$118.27
KY$102.36$119.31
LA$102.36$119.31
MA$108.06$119.31
MD$102.47$119.31
ME$108.06$119.31
MI$105.42$119.31
MN$101.28$119.31
MO$101.28$119.31
MS$102.36$119.31
MT$104.17$118.27
NC$102.36$119.31
ND$101.28$118.27
NE$101.28$118.27
NH$108.06$119.31
NJ$102.47$119.31
NM$101.54$119.31
NV$98.38$118.27
NY$102.47$119.31
OH$105.42$119.31
OK$101.54$119.31
OR$98.38$118.27
PA$102.47$119.31
PR$131.84—
RI$108.06$119.31
SC$102.36$119.31
SD$101.28$118.27
TN$102.36$119.31
TX$101.54$119.31
UT$104.17$119.31
VA$102.36$119.31
VI$119.31—
VT$108.06$119.31
WA$98.38$119.31
WI$105.42$119.31
WV$102.36$119.31
WY$104.17$118.27

NU + KE — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $127.21 to $142.74 depending on state and rural status.

StateNon-ruralRural
AK$127.21—
AL—$128.40
AR—$128.40
AZ—$127.21
CA—$127.21
CO—$128.40
CT—$128.40
DC—$128.40
DE—$128.40
FL—$128.40
GA—$128.40
HI$127.21—
IA—$127.21
ID—$127.21
IL—$128.40
IN—$128.40
KS—$127.21
KY—$128.40
LA—$128.40
MA—$128.40
MD—$128.40
ME—$128.40
MI—$128.40
MN—$128.40
MO—$128.40
MS—$128.40
MT—$127.21
NC—$128.40
ND—$127.21
NE—$127.21
NH—$128.40
NJ—$128.40
NM—$128.40
NV—$127.21
NY—$128.40
OH—$128.40
OK—$128.40
OR—$127.21
PA—$128.40
PR$142.74—
RI—$128.40
SC—$128.40
SD—$127.21
TN—$128.40
TX—$128.40
UT—$128.40
VA—$128.40
VI$128.40—
VT—$128.40
WA—$128.40
WI—$128.40
WV—$128.40
WY—$127.21

NU + KU — New purchase Inexpensive or routinely purchased

Medicare allowable ranges from $123.23 to $150.37 depending on state and rural status.

Former-CBA payment limits: ceiling $125.31 · floor $106.51

StateNon-ruralRural
AK$123.23—
AL$125.31—
AR$125.31—
AZ$123.23—
CA$123.23—
CO$125.31—
CT$125.31—
DC$125.31—
DE$125.31—
FL$125.31—
GA$125.31—
HI$123.23—
IA$123.23—
ID$123.23—
IL$125.31—
IN$125.31—
KS$123.23—
KY$125.31—
LA$125.31—
MA$125.31—
MD$125.31—
ME$125.31—
MI$125.31—
MN$125.31—
MO$125.31—
MS$125.31—
MT$123.23—
NC$125.31—
ND$123.23—
NE$123.23—
NH$125.31—
NJ$125.31—
NM$125.31—
NV$123.23—
NY$125.31—
OH$125.31—
OK$125.31—
OR$123.23—
PA$125.31—
PR$150.37—
RI$125.31—
SC$125.31—
SD$123.23—
TN$125.31—
TX$125.31—
UT$125.31—
VA$125.31—
VI$125.31—
VT$125.31—
WA$125.31—
WI$125.31—
WV$125.31—
WY$123.23—

RR — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $9.84 to $13.18 depending on state and rural status.

StateNon-ruralRural
AK$11.83—
AL$10.24$11.93
AR$10.24$11.93
AZ$10.16$11.83
CA$9.84$11.83
CO$10.42$11.93
CT$10.81$11.93
DC$10.25$11.93
DE$10.25$11.93
FL$10.24$11.93
GA$10.24$11.93
HI$11.83—
IA$10.13$11.83
ID$10.42$11.83
IL$10.54$11.93
IN$10.54$11.93
KS$10.13$11.83
KY$10.24$11.93
LA$10.24$11.93
MA$10.81$11.93
MD$10.25$11.93
ME$10.81$11.93
MI$10.54$11.93
MN$10.13$11.93
MO$10.13$11.93
MS$10.24$11.93
MT$10.42$11.83
NC$10.24$11.93
ND$10.13$11.83
NE$10.13$11.83
NH$10.81$11.93
NJ$10.25$11.93
NM$10.16$11.93
NV$9.84$11.83
NY$10.25$11.93
OH$10.54$11.93
OK$10.16$11.93
OR$9.84$11.83
PA$10.25$11.93
PR$13.18—
RI$10.81$11.93
SC$10.24$11.93
SD$10.13$11.83
TN$10.24$11.93
TX$10.16$11.93
UT$10.42$11.93
VA$10.24$11.93
VI$11.93—
VT$10.81$11.93
WA$9.84$11.93
WI$10.54$11.93
WV$10.24$11.93
WY$10.42$11.83

RR + KE — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $12.72 to $14.27 depending on state and rural status.

StateNon-ruralRural
AK$12.72—
AL—$12.83
AR—$12.83
AZ—$12.72
CA—$12.72
CO—$12.83
CT—$12.83
DC—$12.83
DE—$12.83
FL—$12.83
GA—$12.83
HI$12.72—
IA—$12.72
ID—$12.72
IL—$12.83
IN—$12.83
KS—$12.72
KY—$12.83
LA—$12.83
MA—$12.83
MD—$12.83
ME—$12.83
MI—$12.83
MN—$12.83
MO—$12.83
MS—$12.83
MT—$12.72
NC—$12.83
ND—$12.72
NE—$12.72
NH—$12.83
NJ—$12.83
NM—$12.83
NV—$12.72
NY—$12.83
OH—$12.83
OK—$12.83
OR—$12.72
PA—$12.83
PR$14.27—
RI—$12.83
SC—$12.83
SD—$12.72
TN—$12.83
TX—$12.83
UT—$12.83
VA—$12.83
VI$12.83—
VT—$12.83
WA—$12.83
WI—$12.83
WV—$12.83
WY—$12.72

RR + KU — Monthly rental Inexpensive or routinely purchased

Medicare allowable ranges from $12.32 to $15.00 depending on state and rural status.

Former-CBA payment limits: ceiling $12.53 · floor $10.65

StateNon-ruralRural
AK$12.32—
AL$12.53—
AR$12.53—
AZ$12.32—
CA$12.32—
CO$12.53—
CT$12.53—
DC$12.53—
DE$12.53—
FL$12.53—
GA$12.53—
HI$12.32—
IA$12.32—
ID$12.32—
IL$12.53—
IN$12.53—
KS$12.32—
KY$12.53—
LA$12.53—
MA$12.53—
MD$12.53—
ME$12.53—
MI$12.53—
MN$12.53—
MO$12.53—
MS$12.53—
MT$12.32—
NC$12.53—
ND$12.32—
NE$12.32—
NH$12.53—
NJ$12.53—
NM$12.53—
NV$12.32—
NY$12.53—
OH$12.53—
OK$12.53—
OR$12.32—
PA$12.53—
PR$15.00—
RI$12.53—
SC$12.53—
SD$12.32—
TN$12.53—
TX$12.53—
UT$12.53—
VA$12.53—
VI$12.53—
VT$12.53—
WA$12.53—
WI$12.53—
WV$12.53—
WY$12.32—

UE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $73.78 to $98.89 depending on state and rural status.

StateNon-ruralRural
AK$88.69—
AL$76.77$89.48
AR$76.77$89.48
AZ$76.16$88.69
CA$73.78$88.69
CO$78.13$89.48
CT$81.04$89.48
DC$76.85$89.48
DE$76.85$89.48
FL$76.77$89.48
GA$76.77$89.48
HI$88.69—
IA$75.96$88.69
ID$78.13$88.69
IL$79.06$89.48
IN$79.06$89.48
KS$75.96$88.69
KY$76.77$89.48
LA$76.77$89.48
MA$81.04$89.48
MD$76.85$89.48
ME$81.04$89.48
MI$79.06$89.48
MN$75.96$89.48
MO$75.96$89.48
MS$76.77$89.48
MT$78.13$88.69
NC$76.77$89.48
ND$75.96$88.69
NE$75.96$88.69
NH$81.04$89.48
NJ$76.85$89.48
NM$76.16$89.48
NV$73.78$88.69
NY$76.85$89.48
OH$79.06$89.48
OK$76.16$89.48
OR$73.78$88.69
PA$76.85$89.48
PR$98.89—
RI$81.04$89.48
SC$76.77$89.48
SD$75.96$88.69
TN$76.77$89.48
TX$76.16$89.48
UT$78.13$89.48
VA$76.77$89.48
VI$89.48—
VT$81.04$89.48
WA$73.78$89.48
WI$79.06$89.48
WV$76.77$89.48
WY$78.13$88.69

UE + KE — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $95.38 to $107.07 depending on state and rural status.

StateNon-ruralRural
AK$95.38—
AL—$96.30
AR—$96.30
AZ—$95.38
CA—$95.38
CO—$96.30
CT—$96.30
DC—$96.30
DE—$96.30
FL—$96.30
GA—$96.30
HI$95.38—
IA—$95.38
ID—$95.38
IL—$96.30
IN—$96.30
KS—$95.38
KY—$96.30
LA—$96.30
MA—$96.30
MD—$96.30
ME—$96.30
MI—$96.30
MN—$96.30
MO—$96.30
MS—$96.30
MT—$95.38
NC—$96.30
ND—$95.38
NE—$95.38
NH—$96.30
NJ—$96.30
NM—$96.30
NV—$95.38
NY—$96.30
OH—$96.30
OK—$96.30
OR—$95.38
PA—$96.30
PR$107.07—
RI—$96.30
SC—$96.30
SD—$95.38
TN—$96.30
TX—$96.30
UT—$96.30
VA—$96.30
VI$96.30—
VT—$96.30
WA—$96.30
WI—$96.30
WV—$96.30
WY—$95.38

UE + KU — Used purchase Inexpensive or routinely purchased

Medicare allowable ranges from $92.37 to $112.79 depending on state and rural status.

Former-CBA payment limits: ceiling $93.97 · floor $79.87

StateNon-ruralRural
AK$92.37—
AL$93.97—
AR$93.97—
AZ$92.37—
CA$92.37—
CO$93.97—
CT$93.97—
DC$93.97—
DE$93.97—
FL$93.97—
GA$93.97—
HI$92.37—
IA$92.37—
ID$92.37—
IL$93.97—
IN$93.97—
KS$92.37—
KY$93.97—
LA$93.97—
MA$93.97—
MD$93.97—
ME$93.97—
MI$93.97—
MN$93.97—
MO$93.97—
MS$93.97—
MT$92.37—
NC$93.97—
ND$92.37—
NE$92.37—
NH$93.97—
NJ$93.97—
NM$93.97—
NV$92.37—
NY$93.97—
OH$93.97—
OK$93.97—
OR$92.37—
PA$93.97—
PR$112.79—
RI$93.97—
SC$93.97—
SD$92.37—
TN$93.97—
TX$93.97—
UT$93.97—
VA$93.97—
VI$93.97—
VT$93.97—
WA$93.97—
WI$93.97—
WV$93.97—
WY$92.37—
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 K0053 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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