| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
1,564 |
1,003 |
$205K |
| 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 |
656 |
633 |
$96K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
344 |
228 |
$70K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
46 |
30 |
$10K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
97 |
68 |
$4K |
| 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 |
74 |
45 |
$4K |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
24 |
12 |
$3K |
| L2280 |
Addition to lower extremity, molded inner boot |
25 |
12 |
$3K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
36 |
29 |
$1K |
| 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 |
13 |
13 |
$540.46 |