| Code | Description | Claims | Bene. Records | 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 |
2,069 |
951 |
$114K |
| 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 |
2,589 |
1,252 |
$90K |
| L3002 |
Foot, insert, removable, molded to patient model, plastazote or equal, each |
136 |
67 |
$17K |