| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
550 |
545 |
$11K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
690 |
563 |
$8K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
7,709 |
7,477 |
$6K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
667 |
658 |
$6K |
| K0004 |
High strength, lightweight wheelchair |
67 |
65 |
$4K |
| L3915 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
225 |
153 |
$4K |
| L2810 |
Addition to lower extremity orthosis, knee control, condylar pad |
707 |
584 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
327 |
235 |
$1K |
| L2795 |
Addition to lower extremity orthosis, knee control, full kneecap |
676 |
553 |
$1K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
729 |
598 |
$996.92 |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
653 |
604 |
$684.44 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
51 |
51 |
$669.96 |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
52 |
52 |
$542.10 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
52 |
52 |
$462.60 |
| K0001 |
Standard wheelchair |
78 |
75 |
$190.66 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
40 |
40 |
$163.88 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
51 |
51 |
$152.38 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
52 |
52 |
$144.66 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
53 |
53 |
$101.48 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
53 |
53 |
$92.56 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
12 |
12 |
$0.00 |
| K0553 |
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
112 |
110 |
$0.00 |