| Code | Description | Claims | Bene. Records | 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 |
197 |
104 |
$10K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
38 |
26 |
$7K |
| 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 |
51 |
34 |
$2K |