| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 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 |
370 |
242 |
$45K |
| 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 |
235 |
163 |
$19K |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
55 |
39 |
$15K |
| L3230 |
Orthopedic footwear, custom shoe, depth inlay, each |
59 |
41 |
$15K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
132 |
85 |
$7K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
17 |
13 |
$1K |