| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
5,857 |
4,212 |
$1.25M |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
1,267 |
934 |
$779K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
1,024 |
713 |
$711K |
| 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 |
744 |
594 |
$558K |
| L2280 |
Addition to lower extremity, molded inner boot |
791 |
516 |
$541K |
| 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 |
6,852 |
4,836 |
$431K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
3,297 |
2,396 |
$415K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
842 |
579 |
$345K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
4,304 |
3,248 |
$334K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
351 |
210 |
$256K |
| 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 |
4,640 |
3,312 |
$222K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,523 |
1,488 |
$159K |
| L0174 |
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
662 |
612 |
$147K |
| L3202 |
Orthopedic shoe, oxford with supinator or pronator, child |
1,151 |
708 |
$99K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
838 |
627 |
$95K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
254 |
201 |
$80K |
| L5000 |
Partial foot, shoe insert with longitudinal arch, toe filler |
182 |
164 |
$75K |
| L3260 |
Surgical boot/shoe, each |
1,131 |
1,076 |
$68K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
2,284 |
2,206 |
$61K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
39 |
31 |
$59K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
328 |
265 |
$42K |
| 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 |
1,034 |
999 |
$40K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
144 |
143 |
$40K |
| L5637 |
Addition to lower extremity, below knee, total contact |
164 |
134 |
$39K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
117 |
93 |
$36K |
| L5620 |
Addition to lower extremity, test socket, below knee |
155 |
123 |
$36K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
985 |
970 |
$32K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
378 |
365 |
$30K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
412 |
330 |
$26K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
131 |
108 |
$26K |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
62 |
58 |
$21K |
| 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 |
300 |
300 |
$18K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
645 |
605 |
$17K |
| 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 |
332 |
272 |
$16K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
463 |
454 |
$14K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
126 |
104 |
$12K |
| 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 |
51 |
42 |
$12K |
| K0903 |
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 |
258 |
193 |
$12K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
46 |
40 |
$11K |
| 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 |
306 |
246 |
$9K |
| 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 |
71 |
68 |
$9K |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
31 |
31 |
$9K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
253 |
219 |
$5K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
39 |
39 |
$4K |
| L8440 |
Prosthetic shrinker, below knee, each |
76 |
67 |
$4K |
| L3995 |
Addition to upper extremity orthosis, sock, fracture or equal, each |
133 |
131 |
$3K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
14 |
12 |
$3K |
| L2210 |
Addition to lower extremity, dorsiflexion assist (plantar flexion resist), each joint |
20 |
16 |
$2K |
| L0172 |
Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf |
26 |
25 |
$2K |
| 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 |
12 |
12 |
$1K |
| A4565 |
Slings |
53 |
51 |
$867.71 |
| L0999 |
Addition to spinal orthosis, not otherwise specified |
56 |
55 |
$707.37 |
| L3650 |
Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf |
16 |
15 |
$451.06 |