| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
4,261 |
2,455 |
$831K |
| 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 |
4,591 |
2,868 |
$281K |
| 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 |
3,670 |
2,420 |
$201K |
| 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 |
559 |
494 |
$45K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
591 |
523 |
$37K |
| A5507 |
For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe |
1,013 |
783 |
$32K |
| 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 |
884 |
604 |
$28K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
179 |
179 |
$26K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
123 |
114 |
$23K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
255 |
150 |
$19K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
424 |
295 |
$17K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
258 |
248 |
$16K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
89 |
88 |
$13K |
| 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 |
40 |
40 |
$10K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
51 |
38 |
$8K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
86 |
78 |
$5K |
| 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 |
56 |
56 |
$5K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
70 |
64 |
$4K |
| L2830 |
Addition to lower extremity orthosis, soft interface for molded plastic, above knee section |
17 |
17 |
$1K |