| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6549 |
Gradient compression garment, not otherwise specified, for daytime use, each |
364 |
201 |
$57K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
885 |
450 |
$34K |
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
149 |
147 |
$18K |
| 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 |
109 |
56 |
$4K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
49 |
25 |
$4K |
| 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 |
72 |
40 |
$2K |
| L0630 |
Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, 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 |
12 |
12 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
126 |
99 |
$940.66 |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
69 |
54 |
$907.50 |
| L3020 |
Foot, insert, removable, molded to patient model, longitudinal/ metatarsal support, each |
24 |
12 |
$0.00 |