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CGS Administrators, LLC

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January 7, 2019 - Revised: 02.01.19

2019 Jurisdiction C Labor Fees

The labor payment amounts for the HCPCS codes below are effective for claims submitted for Jurisdiction C states with dates of service from January 1, 2019 through December 31, 2019.

K0739 – Repair or nonroutine service for DME other than oxygen requiring the skill of a technician, labor component, per 15 minutes
L4205 – Repair of orthotic device, labor component, per 15 minutes
L7520 – Repair of prosthetic device, labor component, per 15 minutes

State K0739 L4205 L7520
AL $15.70 $23.40 $31.77
AR $15.70 $23.40 $31.77
CO $15.70 $23.40 $31.77
FL $15.70 $23.40 $31.77
GA $15.70 $23.40 $31.77
LA $15.70 $23.40 $31.77
MS $15.70 $23.40 $31.77
NC $15.70 $23.40 $31.77
NM $15.70 $23.40 $31.77
OK $15.70 $23.40 $31.77
PR $15.70 $23.40 $31.77
SC $15.70 $23.40 $31.77
TN $15.70 $23.40 $31.77
TX $15.70 $23.40 $31.77
VA $15.70 $23.37 $31.77
VI $15.70 $23.40 $31.77
WV $15.70 $23.37 $31.77
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