| 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 |
1,478 |
1,253 |
$92K |
| 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 |
1,572 |
1,285 |
$58K |
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
125 |
110 |
$54K |
| L5620 |
Addition to lower extremity, test socket, below knee |
204 |
187 |
$36K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
261 |
239 |
$35K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
155 |
132 |
$31K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
216 |
198 |
$28K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
219 |
201 |
$24K |
| L5637 |
Addition to lower extremity, below knee, total contact |
244 |
225 |
$23K |
| L7520 |
Repair prosthetic device, labor component, per 15 minutes |
531 |
463 |
$20K |
| L5679 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, not for use with locking mechanism |
37 |
37 |
$17K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
308 |
285 |
$8K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
37 |
36 |
$3K |
| L7510 |
Repair of prosthetic device, repair or replace minor parts |
152 |
139 |
$3K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
217 |
202 |
$2K |
| L8440 |
Prosthetic shrinker, below knee, each |
69 |
64 |
$1K |