| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
5,168 |
2,964 |
$346K |
| 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 |
2,612 |
1,472 |
$107K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
1,535 |
786 |
$105K |
| L3215 |
Orthopedic footwear, ladies shoe, oxford, each |
1,236 |
665 |
$100K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
248 |
173 |
$89K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
721 |
440 |
$83K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
1,633 |
1,009 |
$54K |
| L3219 |
Orthopedic footwear, mens shoe, oxford, each |
362 |
192 |
$34K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
479 |
299 |
$28K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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 |
99 |
49 |
$4K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
48 |
29 |
$3K |