| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L1833 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf |
903 |
811 |
$414K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
2,298 |
2,099 |
$395K |
| L1846 |
Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, custom fabricated |
332 |
283 |
$291K |
| L3809 |
Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type |
1,169 |
1,072 |
$167K |
| L2425 |
Addition to knee joint, disc or dial lock for adjustable knee flexion, each joint |
245 |
204 |
$51K |
| L2755 |
Addition to lower extremity orthosis, high strength, lightweight material, all hybrid lamination/prepreg composite, per segment, for custom fabricated orthosis only |
332 |
286 |
$46K |
| L1902 |
Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf |
965 |
892 |
$45K |
| L3984 |
Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment |
119 |
112 |
$27K |
| L2830 |
Addition to lower extremity orthosis, soft interface for molded plastic, above knee section |
236 |
198 |
$16K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
185 |
172 |
$15K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
459 |
438 |
$15K |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
202 |
177 |
$15K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
243 |
199 |
$14K |
| L3960 |
Shoulder elbow wrist hand orthosis, abduction positioning, airplane design, prefabricated, includes fitting and adjustment |
26 |
26 |
$13K |
| E0114 |
Crutches underarm, other than wood, adjustable or fixed, pair, with pads, tips and handgrips |
241 |
227 |
$11K |
| L2795 |
Addition to lower extremity orthosis, knee control, full kneecap |
147 |
137 |
$7K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
234 |
225 |
$6K |
| E0261 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress |
612 |
594 |
$5K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
1,465 |
1,417 |
$4K |
| L3660 |
Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf |
57 |
54 |
$3K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
1,515 |
1,463 |
$2K |
| K0003 |
Lightweight wheelchair |
405 |
397 |
$2K |
| K0001 |
Standard wheelchair |
445 |
430 |
$2K |
| 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 |
314 |
222 |
$1K |
| L1820 |
Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
12 |
12 |
$967.54 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
198 |
193 |
$442.82 |
| E0165 |
Commode chair, mobile or stationary, with detachable arms |
77 |
75 |
$428.17 |
| 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 |
312 |
222 |
$12.88 |