| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 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 |
10,148 |
5,511 |
$490K |
| 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 |
4,280 |
3,590 |
$453K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,212 |
2,079 |
$136K |
| A4259 |
Lancets, per box of 100 |
2,006 |
1,906 |
$26K |
| A4245 |
Alcohol wipes, per box |
739 |
722 |
$5K |
| E0607 |
Home blood glucose monitor |
72 |
70 |
$3K |
| A4256 |
Normal, low and high calibrator solution / chips |
401 |
385 |
$2K |
| A4258 |
Spring-powered device for lancet, each |
77 |
74 |
$912.12 |
| 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 |
2,480 |
1,523 |
$413.48 |
| A4234 |
Replacement battery, alkaline, j cell, for use with medically necessary home blood glucose monitor owned by patient, each |
263 |
258 |
$376.20 |