| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
56 |
42 |
$32K |
| 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 |
429 |
206 |
$19K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
83 |
38 |
$13K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
18 |
14 |
$9K |
| 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 |
84 |
44 |
$8K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
35 |
27 |
$7K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
18 |
14 |
$4K |
| L5620 |
Addition to lower extremity, test socket, below knee |
18 |
14 |
$4K |
| L5637 |
Addition to lower extremity, below knee, total contact |
18 |
14 |
$3K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
17 |
13 |
$3K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
17 |
13 |
$3K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
52 |
29 |
$2K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
20 |
16 |
$2K |
| L8440 |
Prosthetic shrinker, below knee, each |
21 |
17 |
$1K |
| L8400 |
Prosthetic sheath, below knee, each |
20 |
16 |
$887.60 |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
18 |
14 |
$635.48 |