| 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 |
9,597 |
4,786 |
$432K |
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
1,532 |
769 |
$350K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
5,134 |
2,554 |
$214K |
| 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 |
5,483 |
2,744 |
$200K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
768 |
753 |
$176K |
| 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 |
3,382 |
1,849 |
$112K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
1,155 |
570 |
$70K |
| L0633 |
Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on 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 |
312 |
304 |
$55K |
| A6539 |
Gradient compression stocking, waist length, 18-30 mmhg, each |
370 |
301 |
$52K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,068 |
670 |
$49K |
| 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 |
42 |
42 |
$38K |
| L1906 |
Ankle foot orthosis, multiligamentous ankle support, prefabricated, off-the-shelf |
325 |
292 |
$31K |
| L5000 |
Partial foot, shoe insert with longitudinal arch, toe filler |
73 |
63 |
$13K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
200 |
166 |
$11K |
| 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 |
100 |
85 |
$8K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
126 |
125 |
$7K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
97 |
80 |
$6K |
| A6545 |
Gradient compression wrap, non-elastic, below knee, 30-50 mmhg, used as a surgical dressing, each |
74 |
36 |
$6K |
| L1812 |
Knee orthosis, elastic with joints, prefabricated, off-the-shelf |
41 |
37 |
$4K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
13 |
13 |
$3K |
| L0643 |
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, off-the-shelf |
13 |
13 |
$2K |