| 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 |
1,656 |
1,639 |
$273K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
629 |
326 |
$166K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
3,797 |
3,409 |
$159K |
| 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 |
371 |
358 |
$138K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
1,802 |
1,124 |
$95K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
1,886 |
1,096 |
$91K |
| L2768 |
Orthotic side bar disconnect device, per bar |
1,208 |
612 |
$89K |
| L2280 |
Addition to lower extremity, molded inner boot |
374 |
226 |
$79K |
| 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 |
1,111 |
1,039 |
$75K |
| L2200 |
Addition to lower extremity, limited ankle motion, each joint |
1,396 |
767 |
$67K |
| L1960 |
Ankle foot orthosis, posterior solid ankle, plastic, custom fabricated |
203 |
124 |
$54K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
121 |
80 |
$40K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
490 |
490 |
$28K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
295 |
285 |
$28K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
102 |
101 |
$19K |
| L1846 |
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
24 |
24 |
$17K |
| 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 |
311 |
161 |
$11K |
| 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 |
291 |
163 |
$6K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
23 |
12 |
$6K |
| L1830 |
Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf |
86 |
85 |
$5K |
| 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 |
48 |
45 |
$4K |
| 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 |
17 |
17 |
$4K |
| L3670 |
Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf |
28 |
28 |
$2K |