| Code | Description | Total Paid |
|---|
| S1040 |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
$1.25M |
| A8003 |
Helmet, protective, hard, custom fabricated, includes all components and accessories |
$675K |
| L2275 |
Addition to lower extremity, varus/valgus correction, plastic modification, padded/lined |
$184K |
| L2280 |
Addition to lower extremity, molded inner boot |
$114K |
| 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 |
$90K |
| L1907 |
Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
$79K |
| L2820 |
Addition to lower extremity orthosis, soft interface for molded plastic, below knee section |
$73K |
| 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 |
$69K |
| L5671 |
Addition to lower extremity, below knee / above knee suspension locking mechanism (shuttle, lanyard or equal), excludes socket insert |
$59K |
| L1970 |
Ankle foot orthosis, plastic with ankle joint, custom fabricated |
$53K |