| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L4360 |
Walking boot, pneumatic and/or vacuum, 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 |
909 |
861 |
$182K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
631 |
542 |
$162K |
| 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 |
1,160 |
880 |
$140K |
| 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 |
1,132 |
886 |
$97K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
609 |
493 |
$95K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
618 |
508 |
$70K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
421 |
373 |
$26K |
| 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 |
217 |
204 |
$25K |
| L2280 |
Addition to lower extremity, molded inner boot |
29 |
24 |
$18K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
182 |
138 |
$12K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
98 |
87 |
$7K |
| L3206 |
Orthopedic shoe, hightop with supinator or pronator, child |
127 |
82 |
$6K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
92 |
89 |
$6K |
| 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 |
12 |
12 |
$3K |
| 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 |
12 |
12 |
$3K |