| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
775 |
771 |
$1.07M |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
3,126 |
1,622 |
$384K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
939 |
526 |
$372K |
| 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 |
6,953 |
3,861 |
$331K |
| L4387 |
Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf |
3,630 |
3,596 |
$331K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
13,869 |
9,254 |
$328K |
| L2280 |
Addition to lower extremity, molded inner boot |
922 |
451 |
$290K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
3,716 |
1,890 |
$275K |
| 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 |
4,070 |
2,113 |
$226K |
| 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 |
3,010 |
1,622 |
$214K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
5,209 |
3,996 |
$200K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
2,395 |
2,150 |
$195K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,225 |
1,142 |
$161K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
1,052 |
1,030 |
$153K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
3,013 |
1,606 |
$137K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
3,526 |
2,390 |
$127K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
215 |
120 |
$78K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
1,676 |
1,579 |
$73K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
1,631 |
1,570 |
$70K |
| L4386 |
Walking boot, non-pneumatic, 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 |
747 |
733 |
$68K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
2,383 |
2,368 |
$60K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
304 |
262 |
$40K |
| A6531 |
Gradient compression stocking, below knee, 30-40 mmhg, used as a surgical dressing, each |
1,107 |
823 |
$31K |
| L0627 |
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 item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
136 |
136 |
$30K |
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
69 |
68 |
$27K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
422 |
381 |
$16K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
261 |
150 |
$15K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
24 |
24 |
$9K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
25 |
13 |
$8K |
| L3260 |
Surgical boot/shoe, each |
167 |
165 |
$7K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
79 |
79 |
$5K |
| L4350 |
Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf |
73 |
73 |
$4K |
| 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 |
19 |
19 |
$4K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
322 |
322 |
$4K |
| L4397 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf |
30 |
24 |
$3K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
25 |
24 |
$1K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
15 |
13 |
$1K |
| E0156 |
Seat attachment, walker |
66 |
66 |
$866.48 |
| A6534 |
Gradient compression stocking, thigh length, 30-40 mmhg, each |
15 |
13 |
$599.70 |