| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
6,731 |
2,371 |
$659K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
2,316 |
1,217 |
$523K |
| 11721 |
|
17,912 |
17,653 |
$508K |
| 97610 |
|
1,882 |
432 |
$451K |
| 11056 |
|
18,033 |
17,841 |
$375K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
5,783 |
5,751 |
$312K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13,494 |
10,693 |
$310K |
| 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 |
6,194 |
3,249 |
$273K |
| 20550 |
|
3,560 |
1,724 |
$209K |
| 29540 |
|
10,167 |
2,948 |
$181K |
| 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 |
2,720 |
1,674 |
$159K |
| 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 |
2,031 |
1,191 |
$159K |
| Q4186 |
Epifix, per square centimeter (add-on, list separately in addition to primary procedure) |
172 |
68 |
$156K |
| 11750 |
|
1,647 |
1,236 |
$131K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
827 |
508 |
$76K |
| 97032 |
|
2,742 |
691 |
$66K |
| A6021 |
Collagen dressing, sterile, size 16 sq. in. or less, each |
129 |
128 |
$50K |
| 29581 |
|
524 |
168 |
$39K |
| 97124 |
|
2,737 |
692 |
$27K |
| 17110 |
|
135 |
91 |
$14K |
| 15275 |
|
166 |
68 |
$13K |
| A6222 |
Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
155 |
151 |
$5K |
| 11057 |
|
192 |
187 |
$4K |
| A6448 |
Light compression bandage, elastic, knitted/woven, width less than three inches, per yard |
12 |
12 |
$449.84 |
| G0127 |
Trimming of dystrophic nails, any number |
17 |
17 |
$141.74 |
| G8410 |
Footwear evaluation performed and documented |
8,278 |
6,241 |
$116.14 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
114 |
42 |
$20.48 |
| G8404 |
Lower extremity neurological exam performed and documented |
8,293 |
6,259 |
$5.00 |
| G8730 |
Pain assessment documented as positive using a standardized tool and a follow-up plan is documented |
327 |
295 |
$0.00 |