| Code | Description | Claims | Beneficiaries | 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 |
178 |
87 |
$4K |
| L1940 |
Ankle foot orthosis, plastic or other material, custom fabricated |
58 |
42 |
$3K |
| L2330 |
Addition to lower extremity, lacer molded to patient model, for custom fabricated orthosis only |
58 |
42 |
$2K |
| 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 |
80 |
40 |
$765.01 |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
58 |
42 |
$454.56 |