| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L0457 |
Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf |
432 |
333 |
$206K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
148 |
142 |
$106K |
| E0652 |
Pneumatic compressor, segmental home model with calibrated gradient pressure |
14 |
14 |
$76K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
59 |
57 |
$15K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
48 |
40 |
$15K |
| E0667 |
Segmental pneumatic appliance for use with pneumatic compressor, full leg |
18 |
14 |
$8K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
47 |
43 |
$8K |
| E0603 |
Breast pump, electric (ac and/or dc), any type |
45 |
31 |
$5K |
| L0642 |
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, off-the-shelf |
13 |
12 |
$3K |
| L0174 |
Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf |
16 |
14 |
$3K |
| L3995 |
Addition to upper extremity orthosis, sock, fracture or equal, each |
43 |
41 |
$2K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
16 |
13 |
$1K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
31 |
27 |
$957.86 |
| E0570 |
Nebulizer, with compressor |
12 |
12 |
$426.24 |
| A7005 |
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable |
12 |
12 |
$143.80 |