| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5637 |
Addition to lower extremity, below knee, total contact |
79 |
43 |
$60K |
| 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 |
399 |
231 |
$52K |
| L5301 |
Below knee, molded socket, shin, sach foot, endoskeletal system |
20 |
12 |
$50K |
| 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 |
406 |
237 |
$45K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
79 |
43 |
$39K |
| 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 |
40 |
23 |
$36K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
79 |
43 |
$28K |
| L5620 |
Addition to lower extremity, test socket, below knee |
47 |
31 |
$27K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
38 |
22 |
$26K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
88 |
48 |
$26K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
33 |
18 |
$22K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
31 |
17 |
$15K |
| L5962 |
Addition, endoskeletal system, below knee, flexible protective outer surface covering system |
26 |
15 |
$15K |
| L5704 |
Custom shaped protective cover, below knee |
24 |
14 |
$11K |
| L5984 |
All endoskeletal lower extremity prosthesis, axial rotation unit, with or without adjustability |
33 |
18 |
$10K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
213 |
86 |
$9K |
| L5685 |
Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each |
82 |
45 |
$9K |
| L5670 |
Addition to lower extremity, below knee, molded supracondylar suspension ('pts' or similar) |
20 |
12 |
$2K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
88 |
48 |
$1K |