| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
677 |
572 |
$199K |
| 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 |
610 |
454 |
$50K |
| A5514 |
For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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 |
500 |
380 |
$30K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
110 |
82 |
$10K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
55 |
50 |
$6K |