| 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 |
6,544 |
3,780 |
$328K |
| 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 |
6,876 |
3,840 |
$201K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
899 |
556 |
$102K |
| L5000 |
Partial foot, shoe insert with longitudinal arch, toe filler |
110 |
80 |
$18K |
| L0650 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf |
13 |
12 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
14 |
12 |
$1K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
14 |
12 |
$1K |