| 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 |
3,913 |
2,403 |
$148K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
309 |
225 |
$68K |
| 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 |
3,183 |
1,884 |
$28K |
| L2340 |
Addition to lower extremity, pre-tibial shell, molded to patient model |
107 |
95 |
$14K |
| 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 |
254 |
157 |
$7K |
| L2250 |
Addition to lower extremity, foot plate, molded to patient model, stirrup attachment |
57 |
54 |
$5K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
138 |
124 |
$4K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
50 |
26 |
$3K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
154 |
122 |
$2K |
| L2840 |
Addition to lower extremity orthosis, tibial length sock, fracture or equal, each |
120 |
108 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
77 |
70 |
$1K |
| L2270 |
Addition to lower extremity, varus/valgus correction ('t') strap, padded/lined or malleolus pad |
58 |
55 |
$776.00 |
| L8020 |
Breast prosthesis, mastectomy form |
23 |
14 |
$217.20 |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
12 |
12 |
$155.00 |
| L3170 |
Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each |
17 |
16 |
$31.04 |