| 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 |
3,650 |
2,819 |
$233K |
| L3010 |
Foot, insert, removable, molded to patient model, longitudinal arch support, each |
1,114 |
946 |
$213K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
1,164 |
1,047 |
$156K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
1,640 |
1,439 |
$145K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
1,841 |
1,453 |
$121K |
| L4360 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
644 |
567 |
$101K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
1,547 |
1,303 |
$82K |
| 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 |
2,051 |
1,695 |
$77K |
| A4670 |
Automatic blood pressure monitor |
902 |
847 |
$54K |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
2,218 |
1,853 |
$45K |
| L0625 |
Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf |
1,092 |
1,012 |
$38K |
| 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 |
308 |
293 |
$30K |
| 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 |
27 |
25 |
$19K |
| A6533 |
Gradient compression stocking, thigh length, 18-30 mmhg, each |
104 |
94 |
$12K |
| 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 |
102 |
99 |
$12K |
| 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 |
352 |
214 |
$10K |
| 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 |
75 |
72 |
$10K |
| L3260 |
Surgical boot/shoe, each |
928 |
764 |
$10K |
| L4361 |
Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf |
126 |
57 |
$9K |
| E0100 |
Cane, includes canes of all materials, adjustable or fixed, with tip |
508 |
476 |
$6K |
| E0156 |
Seat attachment, walker |
465 |
375 |
$5K |
| L1971 |
Ankle foot orthosis, plastic or other material with ankle joint, with or without dorsiflexion assist, prefabricated, includes fitting and adjustment |
14 |
12 |
$4K |
| L0627 |
Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, 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 |
14 |
14 |
$3K |
| E0245 |
Tub stool or bench |
48 |
47 |
$3K |
| E0570 |
Nebulizer, with compressor |
53 |
42 |
$2K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
28 |
27 |
$1K |