| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L5673 |
Addition to lower extremity, below knee/above knee, custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism |
504 |
449 |
$126K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
447 |
405 |
$56K |
| L5645 |
Addition to lower extremity, below knee, flexible inner socket, external frame |
208 |
185 |
$30K |
| L5620 |
Addition to lower extremity, test socket, below knee |
303 |
269 |
$27K |
| L5637 |
Addition to lower extremity, below knee, total contact |
269 |
243 |
$26K |
| L5940 |
Addition, endoskeletal system, below knee, ultra-light material (titanium, carbon fiber or equal) |
188 |
167 |
$26K |
| L5910 |
Addition, endoskeletal system, below knee, alignable system |
269 |
241 |
$25K |
| L5629 |
Addition to lower extremity, below knee, acrylic socket |
237 |
210 |
$21K |
| L5649 |
Addition to lower extremity, ischial containment/narrow m-l socket |
13 |
12 |
$10K |
| L8420 |
Prosthetic sock, multiple ply, below knee, each |
288 |
259 |
$8K |
| L5301 |
Below knee, molded socket, shin, sach foot, endoskeletal system |
14 |
12 |
$7K |
| L5986 |
All lower extremity prostheses, multi-axial rotation unit ('mcp' or equal) |
46 |
41 |
$7K |
| L3807 |
Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
252 |
198 |
$7K |
| L5651 |
Addition to lower extremity, above knee, flexible inner socket, external frame |
13 |
12 |
$6K |
| L1831 |
Knee orthosis, locking knee joint(s), positional orthosis, prefabricated, includes fitting and adjustment |
180 |
124 |
$4K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
106 |
92 |
$4K |
| 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 |
114 |
62 |
$3K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
90 |
76 |
$3K |
| L5650 |
Additions to lower extremity, total contact, above knee or knee disarticulation socket |
13 |
12 |
$3K |
| L5972 |
All lower extremity prostheses, foot, flexible keel |
25 |
25 |
$3K |
| L1832 |
Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
18 |
13 |
$2K |
| L5704 |
Custom shaped protective cover, below knee |
15 |
13 |
$2K |
| L8470 |
Prosthetic sock, single ply, fitting, below knee, each |
247 |
224 |
$1K |
| L4396 |
Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
40 |
26 |
$931.53 |
| 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 |
43 |
24 |
$739.29 |
| L3760 |
Elbow orthosis (eo), with adjustable position locking joint(s), prefabricated, item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
17 |
12 |
$403.70 |