| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
10,898 |
6,053 |
$2.12M |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
15,713 |
8,466 |
$1.47M |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
449 |
447 |
$1.14M |
| 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 |
16,745 |
9,116 |
$688K |
| 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 |
12,946 |
7,024 |
$528K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
10,267 |
7,191 |
$422K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
990 |
900 |
$398K |
| 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 |
1,304 |
1,181 |
$398K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
2,119 |
2,093 |
$284K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,982 |
1,589 |
$280K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
725 |
551 |
$270K |
| 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 |
3,785 |
3,160 |
$244K |
| 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 |
302 |
283 |
$225K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,287 |
1,258 |
$213K |
| A4595 |
Electrical stimulator supplies, 2 lead, per month, (e.g., tens, nmes) |
2,575 |
2,562 |
$195K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
3,277 |
2,524 |
$190K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
952 |
795 |
$181K |
| L5301 |
Below knee, molded socket, shin, sach foot, endoskeletal system |
107 |
99 |
$167K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
2,630 |
1,955 |
$160K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
742 |
738 |
$145K |
| 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 |
3,763 |
2,125 |
$122K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
1,557 |
1,404 |
$120K |
| E0730 |
Transcutaneous electrical nerve stimulation (tens) device, four or more leads, for multiple nerve stimulation |
701 |
699 |
$97K |
| L1810 |
Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
1,590 |
1,355 |
$94K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
2,224 |
1,637 |
$82K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
887 |
673 |
$77K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
177 |
165 |
$57K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
1,332 |
1,107 |
$56K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
214 |
203 |
$51K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
885 |
814 |
$45K |
| L5987 |
All lower extremity prosthesis, shank foot system with vertical loading pylon |
15 |
13 |
$44K |
| L5000 |
Partial foot, shoe insert with longitudinal arch, toe filler |
253 |
218 |
$42K |
| L5637 |
Addition to lower extremity, below knee, total contact |
201 |
190 |
$41K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
127 |
104 |
$37K |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
697 |
637 |
$36K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
504 |
497 |
$35K |
| L5620 |
Addition to lower extremity, test socket, below knee |
202 |
191 |
$31K |
| L2220 |
Addition to lower extremity, dorsiflexion and plantar flexion assist/resist, each joint |
400 |
298 |
$31K |
| L5962 |
Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
106 |
100 |
$30K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
1,093 |
1,092 |
$30K |
| L0648 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
55 |
54 |
$30K |
| L2390 |
Addition to lower extremity, offset knee joint, each joint |
498 |
458 |
$28K |
| L5704 |
Custom shaped protective cover, below knee |
107 |
101 |
$27K |
| L0637 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
41 |
40 |
$25K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
163 |
153 |
$20K |
| L1844 |
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
26 |
22 |
$20K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
214 |
203 |
$19K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
306 |
293 |
$17K |
| L3808 |
Wrist hand finger orthosis, rigid without joints, may include soft interface material; straps, custom fabricated, includes fitting and adjustment |
101 |
79 |
$15K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
492 |
490 |
$14K |
| L4386 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
184 |
181 |
$14K |
| L3260 |
Surgical boot/shoe, each |
220 |
211 |
$13K |
| L5986 |
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) |
42 |
41 |
$12K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
97 |
91 |
$11K |
| 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 |
15 |
15 |
$11K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
167 |
166 |
$11K |
| L8400 |
Prosthetic sheath, below knee, each |
188 |
179 |
$10K |
| L1846 |
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
16 |
15 |
$9K |
| L5668 |
Addition to lower extremity, below knee, molded distal cushion |
88 |
83 |
$8K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
298 |
284 |
$6K |
| L0631 |
Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$6K |
| L8440 |
Prosthetic shrinker, below knee, each |
141 |
132 |
$5K |
| L3710 |
Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf |
80 |
64 |
$4K |
| L2795 |
Addition to lower extremity orthosis, knee control, full kneecap |
84 |
75 |
$4K |
| L1843 |
Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
16 |
15 |
$4K |
| L8417 |
Prosthetic sheath/sock, including a gel cushion layer, below knee or above knee, each |
12 |
12 |
$3K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
31 |
27 |
$2K |
| L5972 |
All lower extremity prostheses, foot, flexible keel |
13 |
13 |
$2K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
28 |
14 |
$2K |
| L0628 |
Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
55 |
54 |
$2K |
| L2830 |
Addition to lower extremity orthosis, soft interface for molded plastic, above knee section |
29 |
27 |
$2K |
| L3310 |
Lift, elevation, heel and sole, neoprene, per inch |
31 |
26 |
$1K |
| L3762 |
Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf |
16 |
13 |
$831.15 |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
13 |
12 |
$807.29 |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
49 |
49 |
$555.22 |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
12 |
12 |
$406.06 |