| 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 |
2,294 |
1,001 |
$46K |
| L5620 |
Addition to lower extremity, test socket, below knee |
237 |
164 |
$31K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
114 |
85 |
$23K |
| 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 |
559 |
269 |
$21K |
| 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 |
729 |
327 |
$21K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
198 |
141 |
$19K |
| L5637 |
Addition to lower extremity, below knee, total contact |
232 |
160 |
$17K |
| L5700 |
Replacement, socket, below knee, molded to patient model |
29 |
26 |
$17K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
126 |
91 |
$17K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
159 |
114 |
$12K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
31 |
24 |
$4K |
| 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 |
21 |
12 |
$4K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
76 |
64 |
$3K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
59 |
50 |
$2K |
| 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 |
12 |
12 |
$706.82 |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
26 |
14 |
$659.12 |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
58 |
50 |
$561.49 |