| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A5513 |
For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each |
3,769 |
1,727 |
$73K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
3,924 |
1,747 |
$45K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
373 |
254 |
$16K |
| L2370 |
Addition to lower extremity, patten bottom |
173 |
78 |
$14K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
550 |
319 |
$14K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
30 |
13 |
$4K |
| L2340 |
Addition to lower extremity, pre-tibial shell, molded to patient model |
28 |
14 |
$3K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
31 |
12 |
$1K |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
24 |
12 |
$1K |