| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
4,862 |
2,472 |
$760K |
| 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 |
7,064 |
3,633 |
$305K |
| 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 |
3,411 |
1,825 |
$138K |
| 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 |
832 |
819 |
$103K |
| 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 |
2,650 |
1,301 |
$88K |
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
469 |
305 |
$87K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,664 |
1,222 |
$57K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
764 |
536 |
$42K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
495 |
334 |
$34K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
413 |
358 |
$29K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
116 |
104 |
$22K |
| 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 |
366 |
315 |
$21K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
332 |
319 |
$18K |
| 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 |
57 |
57 |
$16K |
| 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 |
50 |
39 |
$8K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
27 |
27 |
$5K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
18 |
12 |
$4K |
| L3260 |
Surgical boot/shoe, each |
64 |
61 |
$4K |
| A9999 |
Miscellaneous dme supply or accessory, not otherwise specified |
37 |
30 |
$3K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
53 |
40 |
$2K |
| 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 |
13 |
12 |
$2K |
| 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 |
17 |
13 |
$1K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
33 |
30 |
$527.33 |