| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
1,326 |
695 |
$248K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
28 |
26 |
$68K |
| 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 |
539 |
286 |
$60K |
| 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 |
770 |
380 |
$49K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
203 |
129 |
$26K |
| L4205 |
Repair of orthotic device, labor component, per 15 minutes |
204 |
143 |
$8K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
14 |
12 |
$1K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
38 |
26 |
$975.15 |