| 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 |
152 |
77 |
$4K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
82 |
62 |
$2K |
| L7520 |
Repair prosthetic device, labor component, per 15 minutes |
46 |
38 |
$1K |
| 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 |
24 |
12 |
$444.72 |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
12 |
12 |
$404.31 |