Default Fee Schedule Part 5

Code Price Type Description
K0011 0 HCPCS / CPT® STND WT PWR WHLCHR W CONTROL
K0012 0 HCPCS / CPT® LTWT PORTBL POWER WHLCHR
K0013 0 HCPCS / CPT® CUSTOM POWER WHLCHR BASE
K0014 0 HCPCS / CPT® OTHER POWER WHLCHR BASE
K0015 0 HCPCS / CPT® DETACH NON-ADJ HT ARMRST REP
K0017 0 HCPCS / CPT® DETACH ADJUST ARMREST BASE
K0018 0 HCPCS / CPT® DETACH ADJUST ARMRST UPPER
K0019 0 HCPCS / CPT® ARM PAD REPL, EACH
K0020 0 HCPCS / CPT® FIXED ADJUST ARMREST PAIR
K0037 0 HCPCS / CPT® HI MOUNT FLIP-UP FTREST REPL
K0038 0 HCPCS / CPT® LEG STRAP EACH
K0039 0 HCPCS / CPT® LEG STRAP H STYLE EACH
K0040 0 HCPCS / CPT® ADJUSTABLE ANGLE FOOTPLATE
K0041 0 HCPCS / CPT® LARGE SIZE FOOTPLATE EACH
K0042 0 HCPCS / CPT® STANDARD SIZE FTPLATE REP EA
K0043 0 HCPCS / CPT® FTRST LOWR EXTEN TUBE REP EA
K0044 0 HCPCS / CPT® FTRST UPR HANGER BRAC REP EA
K0045 0 HCPCS / CPT® FTRST COMPL ASSEMBLY REPL EA
K0046 0 HCPCS / CPT® ELEV LGRST LWR EXTEN REPL EA
K0047 0 HCPCS / CPT® ELEV LEGRST UPR HANGR REP EA
K0050 0 HCPCS / CPT® RATCHET ASSEMBLY REPLACEMENT
K0051 0 HCPCS / CPT® CAM REL ASM FT/LEGRST REP EA
K0052 0 HCPCS / CPT® SWINGAWAY DETACH FTREST REPL
K0053 0 HCPCS / CPT® ELEVATE FOOTREST ARTICULATE
K0056 0 HCPCS / CPT® SEAT HT <17 OR >=21 LTWT WC
K0065 0 HCPCS / CPT® SPOKE PROTECTORS
K0069 0 HCPCS / CPT® RR WHL COMPL SOL TIRE REP EA
K0070 0 HCPCS / CPT® RR WHL COMPL PNE TIRE REP EA
K0071 0 HCPCS / CPT® FR CSTR COMP PNE TIRE REP EA
K0072 0 HCPCS / CPT® FR CSTR SEMI-PNE TIRE REP EA
K0073 0 HCPCS / CPT® CASTER PIN LOCK EACH
K0077 0 HCPCS / CPT® FR CSTR ASMB SOL TIRE REP EA
K0098 0 HCPCS / CPT® DRIVE BELT FOR PWC, REPL
K0105 0 HCPCS / CPT® IV HANGER
K0108 0 HCPCS / CPT® W/C COMPONENT-ACCESSORY NOS
K0195 0 HCPCS / CPT® ELEVATING WHLCHAIR LEG RESTS
K0455 0 HCPCS / CPT® PUMP UNINTERRUPTED INFUSION
K0462 0 HCPCS / CPT® TEMPORARY REPLACEMENT EQPMNT
K0552 0 HCPCS / CPT® SUP/EXT NON-INS INF PUMP SYR
K0601 0 HCPCS / CPT® REPL BATT SILVER OXIDE 1.5 V
K0602 0 HCPCS / CPT® REPL BATT SILVER OXIDE 3 V
K0603 0 HCPCS / CPT® REPL BATT ALKALINE 1.5 V
K0604 0 HCPCS / CPT® REPL BATT LITHIUM 3.6 V
K0605 0 HCPCS / CPT® REPL BATT LITHIUM 4.5 V
K0606 0 HCPCS / CPT® AED GARMENT W ELEC ANALYSIS
K0607 0 HCPCS / CPT® REPL BATT FOR AED
K0608 0 HCPCS / CPT® REPL GARMENT FOR AED
K0609 0 HCPCS / CPT® REPL ELECTRODE FOR AED
K0669 0 HCPCS / CPT® SEAT/BACK CUS NO DMEPDAC VER
K0672 0 HCPCS / CPT® REMOVABLE SOFT INTERFACE LE
K0730 0 HCPCS / CPT® CTRL DOSE INH DRUG DELIV SYS
K0733 0 HCPCS / CPT® 12-24HR SEALED LEAD ACID
K0738 0 HCPCS / CPT® PORTABLE GAS OXYGEN SYSTEM
K0739 0 HCPCS / CPT® REPAIR/SVC DME NON-OXYGEN EQ
K0740 0 HCPCS / CPT® REPAIR/SVC OXYGEN EQUIPMENT
K0743 0 HCPCS / CPT® PORTABLE HOME SUCTION PUMP
K0744 0 HCPCS / CPT® ABSORP DRG <= 16 SUC PUMP
K0745 0 HCPCS / CPT® ABSORP DRG >16<=48 SUC PUMP
K0746 0 HCPCS / CPT® ABSORP DRG >48 SUC PUMP
K0800 0 HCPCS / CPT® POV GROUP 1 STD UP TO 300LBS
K0801 0 HCPCS / CPT® POV GROUP 1 HD 301-450 LBS
K0802 0 HCPCS / CPT® POV GROUP 1 VHD 451-600 LBS
K0806 0 HCPCS / CPT® POV GROUP 2 STD UP TO 300LBS
K0807 0 HCPCS / CPT® POV GROUP 2 HD 301-450 LBS
K0808 0 HCPCS / CPT® POV GROUP 2 VHD 451-600 LBS
K0812 0 HCPCS / CPT® POWER OPERATED VEHICLE NOC
K0813 0 HCPCS / CPT® PWC GP 1 STD PORT SEAT/BACK
K0814 0 HCPCS / CPT® PWC GP 1 STD PORT CAP CHAIR
K0815 0 HCPCS / CPT® PWC GP 1 STD SEAT/BACK
K0816 0 HCPCS / CPT® PWC GP 1 STD CAP CHAIR
K0820 0 HCPCS / CPT® PWC GP 2 STD PORT SEAT/BACK
K0821 0 HCPCS / CPT® PWC GP 2 STD PORT CAP CHAIR
K0822 0 HCPCS / CPT® PWC GP 2 STD SEAT/BACK
K0823 0 HCPCS / CPT® PWC GP 2 STD CAP CHAIR
K0824 0 HCPCS / CPT® PWC GP 2 HD SEAT/BACK
K0825 0 HCPCS / CPT® PWC GP 2 HD CAP CHAIR
K0826 0 HCPCS / CPT® PWC GP 2 VHD SEAT/BACK
K0827 0 HCPCS / CPT® PWC GP VHD CAP CHAIR
K0828 0 HCPCS / CPT® PWC GP 2 XTRA HD SEAT/BACK
K0829 0 HCPCS / CPT® PWC GP 2 XTRA HD CAP CHAIR
K0830 0 HCPCS / CPT® PWC GP2 STD SEAT ELEVATE S/B
K0831 0 HCPCS / CPT® PWC GP2 STD SEAT ELEVATE CAP
K0835 0 HCPCS / CPT® PWC GP2 STD SING POW OPT S/B
K0836 0 HCPCS / CPT® PWC GP2 STD SING POW OPT CAP
K0837 0 HCPCS / CPT® PWC GP 2 HD SING POW OPT S/B
K0838 0 HCPCS / CPT® PWC GP 2 HD SING POW OPT CAP
K0839 0 HCPCS / CPT® PWC GP2 VHD SING POW OPT S/B
K0840 0 HCPCS / CPT® PWC GP2 XHD SING POW OPT S/B
K0841 0 HCPCS / CPT® PWC GP2 STD MULT POW OPT S/B
K0842 0 HCPCS / CPT® PWC GP2 STD MULT POW OPT CAP
K0843 0 HCPCS / CPT® PWC GP2 HD MULT POW OPT S/B
K0848 0 HCPCS / CPT® PWC GP 3 STD SEAT/BACK
K0849 0 HCPCS / CPT® PWC GP 3 STD CAP CHAIR
K0850 0 HCPCS / CPT® PWC GP 3 HD SEAT/BACK
K0851 0 HCPCS / CPT® PWC GP 3 HD CAP CHAIR
K0852 0 HCPCS / CPT® PWC GP 3 VHD SEAT/BACK
K0853 0 HCPCS / CPT® PWC GP 3 VHD CAP CHAIR
K0854 0 HCPCS / CPT® PWC GP 3 XHD SEAT/BACK
K0855 0 HCPCS / CPT® PWC GP 3 XHD CAP CHAIR
K0856 0 HCPCS / CPT® PWC GP3 STD SING POW OPT S/B
K0857 0 HCPCS / CPT® PWC GP3 STD SING POW OPT CAP
K0858 0 HCPCS / CPT® PWC GP3 HD SING POW OPT S/B
K0859 0 HCPCS / CPT® PWC GP3 HD SING POW OPT CAP
K0860 0 HCPCS / CPT® PWC GP3 VHD SING POW OPT S/B
K0861 0 HCPCS / CPT® PWC GP3 STD MULT POW OPT S/B
K0862 0 HCPCS / CPT® PWC GP3 HD MULT POW OPT S/B
K0863 0 HCPCS / CPT® PWC GP3 VHD MULT POW OPT S/B
K0864 0 HCPCS / CPT® PWC GP3 XHD MULT POW OPT S/B
K0868 0 HCPCS / CPT® PWC GP 4 STD SEAT/BACK
K0869 0 HCPCS / CPT® PWC GP 4 STD CAP CHAIR
K0870 0 HCPCS / CPT® PWC GP 4 HD SEAT/BACK
K0871 0 HCPCS / CPT® PWC GP 4 VHD SEAT/BACK
K0877 0 HCPCS / CPT® PWC GP4 STD SING POW OPT S/B
K0878 0 HCPCS / CPT® PWC GP4 STD SING POW OPT CAP
K0879 0 HCPCS / CPT® PWC GP4 HD SING POW OPT S/B
K0880 0 HCPCS / CPT® PWC GP4 VHD SING POW OPT S/B
K0884 0 HCPCS / CPT® PWC GP4 STD MULT POW OPT S/B
K0885 0 HCPCS / CPT® PWC GP4 STD MULT POW OPT CAP
K0886 0 HCPCS / CPT® PWC GP4 HD MULT POW S/B
K0890 0 HCPCS / CPT® PWC GP5 PED SING POW OPT S/B
K0891 0 HCPCS / CPT® PWC GP5 PED MULT POW OPT S/B
K0898 0 HCPCS / CPT® POWER WHEELCHAIR NOC
K0899 0 HCPCS / CPT® POW MOBIL DEV NO DMEPDAC
K0900 0 HCPCS / CPT® CSTM DME OTHER THAN WHEELCHR
L0112 0 HCPCS / CPT® CRANIAL CERVICAL ORTHOSIS
L0113 0 HCPCS / CPT® CRANIAL CERVICAL TORTICOLLIS
L0120 0 HCPCS / CPT® CERV FLEX N/ADJ FOAM PRE OTS
L0130 0 HCPCS / CPT® FLEX THERMOPLASTIC COLLAR MO
L0140 0 HCPCS / CPT® CERVICAL SEMI-RIGID ADJUSTAB
L0150 0 HCPCS / CPT® CERV SEMI-RIG ADJ MOLDED CHN
L0160 0 HCPCS / CPT® CERV SR WIRE OCC/MAN PRE OTS
L0170 0 HCPCS / CPT® CERVICAL COLLAR MOLDED TO PT
L0172 37 HCPCS / CPT® CERV COL SR FOAM 2PC PRE OTS
L0174 0 HCPCS / CPT® CERV SR 2PC THOR EXT PRE OTS
L0180 0 HCPCS / CPT® CER POST COL OCC/MAN SUP ADJ
L0190 0 HCPCS / CPT® CERV COLLAR SUPP ADJ CERV BA
L0200 0 HCPCS / CPT® CERV COL SUPP ADJ BAR & THOR
L0220 0 HCPCS / CPT® THOR RIB BELT CUSTOM FABRICA
L0450 0 HCPCS / CPT® TLSO FLEX TRUNK/THOR PRE OTS
L0452 0 HCPCS / CPT® TLSO FLEX CUSTOM FAB THORACI
L0454 0 HCPCS / CPT® TLSO TRNK SJ-T9 PRE CST
L0455 0 HCPCS / CPT® TLSO FLEX TRNK SJ-T9 PRE OTS
L0456 0 HCPCS / CPT® TLSO FLEX TRNK SJ-SS PRE CST
L0457 0 HCPCS / CPT® TLSO FLEX TRNK SJ-SS PRE OTS
L0458 0 HCPCS / CPT® TLSO 2MOD SYMPHIS-XIPHO PRE
L0460 0 HCPCS / CPT® TLSO 2 SHL SYMPHYS-STERN CST
L0462 0 HCPCS / CPT® TLSO 3MOD SACRO-SCAP PRE
L0464 0 HCPCS / CPT® TLSO 4MOD SACRO-SCAP PRE
L0466 0 HCPCS / CPT® TLSO R FRAM SOFT ANT PRE CST
L0467 0 HCPCS / CPT® TLSO R FRAM SOFT PRE OTS
L0468 0 HCPCS / CPT® TLSO RIG FRAM PELVIC PRE CST
L0469 0 HCPCS / CPT® TLSO RIG FRAM PELVIC PRE OTS
L0470 0 HCPCS / CPT® TLSO RIGID FRAME PRE SUBCLAV
L0472 0 HCPCS / CPT® TLSO RIGID FRAME HYPEREX PRE
L0480 0 HCPCS / CPT® TLSO RIGID PLASTIC CUSTOM FA
L0482 0 HCPCS / CPT® TLSO RIGID LINED CUSTOM FAB
L0484 0 HCPCS / CPT® TLSO RIGID PLASTIC CUST FAB
L0486 0 HCPCS / CPT® TLSO RIGIDLINED CUST FAB TWO
L0488 0 HCPCS / CPT® TLSO RIGID LINED PRE ONE PIE
L0490 0 HCPCS / CPT® TLSO RIGID PLASTIC PRE ONE
L0491 0 HCPCS / CPT® TLSO 2 PIECE RIGID SHELL
L0492 0 HCPCS / CPT® TLSO 3 PIECE RIGID SHELL
L0621 0 HCPCS / CPT® SIO FLEX PELVIC/SACR PRE OTS
L0622 0 HCPCS / CPT® SIO FLEX PELVISACRAL CUSTOM
L0623 0 HCPCS / CPT® SIO RIG PNL PELV/SAC PRE OTS
L0624 0 HCPCS / CPT® SIO PANEL CUSTOM
L0625 0 HCPCS / CPT® LO FLEX L1-BELOW L5 PRE OTS
L0626 0 HCPCS / CPT® LO SAG RIG PNL STAYS PRE CST
L0627 0 HCPCS / CPT® LO SAG RI AN/POS PNL PRE CST
L0628 0 HCPCS / CPT® LSO FLEX NO RI STAYS PRE OTS
L0629 0 HCPCS / CPT® LSO FLEX W/RIGID STAYS CUST
L0630 0 HCPCS / CPT® LSO R POST PNL SJ-T9 PRE CST
L0631 0 HCPCS / CPT® LSO SAG R AN/POS PNL PRE CST
L0632 0 HCPCS / CPT® LSO SAG RIGID FRAME CUST
L0633 0 HCPCS / CPT® LSO SC R POS/LAT PNL PRE CST
L0634 0 HCPCS / CPT® LSO FLEXION CONTROL CUSTOM
L0635 0 HCPCS / CPT® LSO SAGIT RIGID PANEL PREFAB
L0636 0 HCPCS / CPT® LSO SAGITTAL RIGID PANEL CUS
L0637 0 HCPCS / CPT® LSO SC R ANT/POS PNL PRE CST
L0638 0 HCPCS / CPT® LSO SAG-CORONAL PANEL CUSTOM
L0639 0 HCPCS / CPT® LSO S/C SHELL/PANEL PREFAB
L0640 0 HCPCS / CPT® LSO S/C SHELL/PANEL CUSTOM
L0641 0 HCPCS / CPT® LO RIG POS PNL L1-L5 PRE OTS
L0642 0 HCPCS / CPT® LO SAG RI AN/POS PNL PRE OTS
L0643 0 HCPCS / CPT® LSO SAG CTR RIGI POS PRE OTS
L0648 0 HCPCS / CPT® LSO SAG R AN/POS PNL PRE OTS
L0649 0 HCPCS / CPT® LSO SC R POS/LAT PNL PRE OTS
L0650 0 HCPCS / CPT® LSO SC R ANT/POS PNL PRE OTS
L0651 0 HCPCS / CPT® LSO SAG-CO SHELL PNL PRE OTS
L0700 0 HCPCS / CPT® CTLSO A-P-L CONTROL MOLDED
L0710 0 HCPCS / CPT® CTLSO A-P-L CONTROL W/ INTER
L0810 0 HCPCS / CPT® HALO CERVICAL INTO JCKT VEST
L0820 0 HCPCS / CPT® HALO CERVICAL INTO BODY JACK
L0830 0 HCPCS / CPT® HALO CERV INTO MILWAUKEE TYP
L0859 0 HCPCS / CPT® MRI COMPATIBLE SYSTEM
L0861 0 HCPCS / CPT® HALO REPL LINER/INTERFACE
L0970 0 HCPCS / CPT® TLSO CORSET FRONT
L0972 0 HCPCS / CPT® LSO CORSET FRONT
L0974 0 HCPCS / CPT® TLSO FULL CORSET
L0976 0 HCPCS / CPT® LSO FULL CORSET
L0978 0 HCPCS / CPT® AXILLARY CRUTCH EXTENSION
L0980 0 HCPCS / CPT® PERONEAL STRAPS PAIR PRE OTS
L0982 0 HCPCS / CPT® STOCKING SUP GRIPS 4 PRE OTS
L0984 0 HCPCS / CPT® PROTECT BODY SOCK EA PRE OTS
L0999 0 HCPCS / CPT® ADD TO SPINAL ORTHOSIS NOS
L1000 0 HCPCS / CPT® CTLSO MILWAUKE INITIAL MODEL
L1001 0 HCPCS / CPT® CTLSO INFANT IMMOBILIZER
L1005 0 HCPCS / CPT® TENSION BASED SCOLIOSIS ORTH
L1010 0 HCPCS / CPT® CTLSO AXILLA SLING
L1020 0 HCPCS / CPT® KYPHOSIS PAD
L1025 0 HCPCS / CPT® KYPHOSIS PAD FLOATING
L1030 0 HCPCS / CPT® LUMBAR BOLSTER PAD
L1040 0 HCPCS / CPT® LUMBAR OR LUMBAR RIB PAD
L1050 0 HCPCS / CPT® STERNAL PAD
L1060 0 HCPCS / CPT® THORACIC PAD
L1070 0 HCPCS / CPT® TRAPEZIUS SLING
L1080 0 HCPCS / CPT® OUTRIGGER
L1085 0 HCPCS / CPT® OUTRIGGER BIL W/ VERT EXTENS
L1090 0 HCPCS / CPT® LUMBAR SLING
L1100 0 HCPCS / CPT® RING FLANGE PLASTIC/LEATHER
L1110 0 HCPCS / CPT® RING FLANGE PLAS/LEATHER MOL
L1120 0 HCPCS / CPT® COVERS FOR UPRIGHT EACH
L1200 0 HCPCS / CPT® FURNSH INITIAL ORTHOSIS ONLY
L1210 0 HCPCS / CPT® LATERAL THORACIC EXTENSION
L1220 0 HCPCS / CPT® ANTERIOR THORACIC EXTENSION
L1230 0 HCPCS / CPT® MILWAUKEE TYPE SUPERSTRUCTUR
L1240 0 HCPCS / CPT® LUMBAR DEROTATION PAD
L1250 0 HCPCS / CPT® ANTERIOR ASIS PAD
L1260 0 HCPCS / CPT® ANTERIOR THORACIC DEROTATION
L1270 0 HCPCS / CPT® ABDOMINAL PAD
L1280 0 HCPCS / CPT® RIB GUSSET (ELASTIC) EACH
L1290 0 HCPCS / CPT® LATERAL TROCHANTERIC PAD
L1300 0 HCPCS / CPT® BODY JACKET MOLD TO PATIENT
L1310 0 HCPCS / CPT® POST-OPERATIVE BODY JACKET
L1499 0 HCPCS / CPT® SPINAL ORTHOSIS NOS
L1600 0 HCPCS / CPT® HO FLEX FREJKA W/COV PRE CST
L1610 0 HCPCS / CPT® HO FREJKA COV ONLY PRE CST
L1620 0 HCPCS / CPT® HO FLEX PAVLIK HARNS PRE CST
L1630 0 HCPCS / CPT® ABDUCT CONTROL HIP SEMI-FLEX
L1640 0 HCPCS / CPT® PELV BAND/SPREAD BAR THIGH C
L1650 0 HCPCS / CPT® HO ABDUCTION HIP ADJUSTABLE
L1652 0 HCPCS / CPT® HO BI THIGHCUFFS W SPRDR BAR
L1660 0 HCPCS / CPT® HO ABDUCTION STATIC PLASTIC
L1680 0 HCPCS / CPT® PELVIC & HIP CONTROL THIGH C
L1685 0 HCPCS / CPT® POST-OP HIP ABDUCT CUSTOM FA
L1686 0 HCPCS / CPT® HO POST-OP HIP ABDUCTION
L1690 0 HCPCS / CPT® COMBINATION BILATERAL HO
L1700 0 HCPCS / CPT® LEG PERTHES ORTH TORONTO TYP
L1710 0 HCPCS / CPT® LEGG PERTHES ORTH NEWINGTON
L1720 0 HCPCS / CPT® LEGG PERTHES ORTHOSIS TRILAT
L1730 0 HCPCS / CPT® LEGG PERTHES ORTH SCOTTISH R
L1755 0 HCPCS / CPT® LEGG PERTHES PATTEN BOTTOM T
L1810 0 HCPCS / CPT® KO ELASTIC WITH JOINTS
L1812 0 HCPCS / CPT® KO ELASTIC W/JOINTS PRE OTS
L1820 0 HCPCS / CPT® KO ELAS W/ CONDYLE PADS & JO
L1830 42 HCPCS / CPT® KO IMMOB CANVAS LONG PRE OTS
L1831 0 HCPCS / CPT® KNEE ORTH POS LOCKING JOINT
L1832 0 HCPCS / CPT® KO ADJ JNT POS R SUP PRE CST
L1833 0 HCPCS / CPT® KO ADJ JNT POS R SUP PRE OTS
L1834 0 HCPCS / CPT® KO W/0 JOINT RIGID MOLDED TO
L1836 0 HCPCS / CPT® KO RIGID W/O JOINTS PRE OTS
L1840 0 HCPCS / CPT® KO DEROT ANT CRUCIATE CUSTOM
L1843 0 HCPCS / CPT® KO SINGLE UPRIGHT PRE CST
L1844 0 HCPCS / CPT® KO W/ADJ JT ROT CNTRL MOLDED
L1845 0 HCPCS / CPT® KO DOUBLE UPRIGHT PRE CST
L1846 0 HCPCS / CPT® KO W ADJ FLEX/EXT ROTAT MOLD
L1847 0 HCPCS / CPT® KO DBL UPRIGHT W/AIR PRE CST
L1848 0 HCPCS / CPT® KO DBL UPRIGHT W/AIR PRE OTS
L1850 0 HCPCS / CPT® KO SWEDISH TYPE PRE OTS
L1851 0 HCPCS / CPT® KO SINGLE UPRIGHT PREFAB OTS
L1852 0 HCPCS / CPT® KO DOUBLE UPRIGHT PREFAB OTS
L1860 0 HCPCS / CPT® KO SUPRACONDYLAR SOCKET MOLD
L1900 0 HCPCS / CPT® AFO SPRNG WIR DRSFLX CALF BD
L1902 0 HCPCS / CPT® AFO ANKLE GAUNTLET PRE OTS
L1904 0 HCPCS / CPT® AFO MOLDED ANKLE GAUNTLET
L1906 121 HCPCS / CPT® AFO MULTILIG ANK SUP PRE OTS
L1907 0 HCPCS / CPT® AFO SUPRAMALLEOLAR CUSTOM
L1910 0 HCPCS / CPT® AFO SING BAR CLASP ATTACH SH
L1920 0 HCPCS / CPT® AFO SING UPRIGHT W/ ADJUST S
L1930 0 HCPCS / CPT® AFO PLASTIC
L1932 0 HCPCS / CPT® AFO RIG ANT TIB PREFAB TCF/=
L1940 0 HCPCS / CPT® AFO MOLDED TO PATIENT PLASTI
L1945 0 HCPCS / CPT® AFO MOLDED PLAS RIG ANT TIB
L1950 0 HCPCS / CPT® AFO SPIRAL MOLDED TO PT PLAS
L1951 0 HCPCS / CPT® AFO SPIRAL PREFABRICATED
L1960 0 HCPCS / CPT® AFO POS SOLID ANK PLASTIC MO
L1970 0 HCPCS / CPT® AFO PLASTIC MOLDED W/ANKLE J
L1971 0 HCPCS / CPT® AFO W/ANKLE JOINT, PREFAB
L1980 0 HCPCS / CPT® AFO SING SOLID STIRRUP CALF
L1990 0 HCPCS / CPT® AFO DOUB SOLID STIRRUP CALF
L2000 0 HCPCS / CPT® KAFO SING FRE STIRR THI/CALF
L2005 0 HCPCS / CPT® KAFO SNG/DBL MECHANICAL ACT
L2010 0 HCPCS / CPT® KAFO SNG SOLID STIRRUP W/O J
L2020 0 HCPCS / CPT® KAFO DBL SOLID STIRRUP BAND/
L2030 0 HCPCS / CPT® KAFO DBL SOLID STIRRUP W/O J
L2034 0 HCPCS / CPT® KAFO PLA SIN UP W/WO K/A CUS
L2035 0 HCPCS / CPT® KAFO PLASTIC PEDIATRIC SIZE
L2036 0 HCPCS / CPT® KAFO PLAS DOUB FREE KNEE MOL
L2037 0 HCPCS / CPT® KAFO PLAS SING FREE KNEE MOL
L2038 0 HCPCS / CPT® KAFO W/O JOINT MULTI-AXIS AN
L2040 0 HCPCS / CPT® HKAFO TORSION BIL ROT STRAPS
L2050 0 HCPCS / CPT® HKAFO TORSION CABLE HIP PELV
L2060 0 HCPCS / CPT® HKAFO TORSION BALL BEARING J
L2070 0 HCPCS / CPT® HKAFO TORSION UNILAT ROT STR
L2080 0 HCPCS / CPT® HKAFO UNILAT TORSION CABLE
L2090 0 HCPCS / CPT® HKAFO UNILAT TORSION BALL BR
L2106 0 HCPCS / CPT® AFO TIB FX CAST PLASTER MOLD
L2108 0 HCPCS / CPT® AFO TIB FX CAST MOLDED TO PT
L2112 0 HCPCS / CPT® AFO TIBIAL FRACTURE SOFT
L2114 0 HCPCS / CPT® AFO TIB FX SEMI-RIGID
L2116 0 HCPCS / CPT® AFO TIBIAL FRACTURE RIGID
L2126 0 HCPCS / CPT® KAFO FEM FX CAST THERMOPLAS
L2128 0 HCPCS / CPT® KAFO FEM FX CAST MOLDED TO P
L2132 0 HCPCS / CPT® KAFO FEMORAL FX CAST SOFT
L2134 0 HCPCS / CPT® KAFO FEM FX CAST SEMI-RIGID
L2136 0 HCPCS / CPT® KAFO FEMORAL FX CAST RIGID
L2180 0 HCPCS / CPT® PLAS SHOE INSERT W ANK JOINT
L2182 0 HCPCS / CPT® DROP LOCK KNEE
L2184 0 HCPCS / CPT® LIMITED MOTION KNEE JOINT
L2186 0 HCPCS / CPT® ADJ MOTION KNEE JNT LERMAN T
L2188 0 HCPCS / CPT® QUADRILATERAL BRIM
L2190 0 HCPCS / CPT® WAIST BELT
L2192 0 HCPCS / CPT® PELVIC BAND & BELT THIGH FLA
L2200 0 HCPCS / CPT® LIMITED ANKLE MOTION EA JNT
L2210 0 HCPCS / CPT® DORSIFLEXION ASSIST EACH JOI
L2220 0 HCPCS / CPT® DORSI & PLANTAR FLEX ASS/RES
L2230 0 HCPCS / CPT® SPLIT FLAT CALIPER STIRR & P
L2232 0 HCPCS / CPT® ROCKER BOTTOM, CONTACT AFO
L2240 0 HCPCS / CPT® ROUND CALIPER AND PLATE ATTA
L2250 0 HCPCS / CPT® FOOT PLATE MOLDED STIRRUP AT
L2260 0 HCPCS / CPT® REINFORCED SOLID STIRRUP
L2265 0 HCPCS / CPT® LONG TONGUE STIRRUP
L2270 0 HCPCS / CPT® VARUS/VALGUS STRAP PADDED/LI
L2275 0 HCPCS / CPT® PLASTIC MOD LOW EXT PAD/LINE
L2280 0 HCPCS / CPT® MOLDED INNER BOOT
L2300 0 HCPCS / CPT® ABDUCTION BAR JOINTED ADJUST
L2310 0 HCPCS / CPT® ABDUCTION BAR-STRAIGHT
L2320 0 HCPCS / CPT® NON-MOLDED LACER
L2330 0 HCPCS / CPT® LACER MOLDED TO PATIENT MODE
L2335 0 HCPCS / CPT® ANTERIOR SWING BAND
L2340 0 HCPCS / CPT® PRE-TIBIAL SHELL MOLDED TO P
L2350 0 HCPCS / CPT® PROSTHETIC TYPE SOCKET MOLDE
L2360 0 HCPCS / CPT® EXTENDED STEEL SHANK
L2370 0 HCPCS / CPT® PATTEN BOTTOM
L2375 0 HCPCS / CPT® TORSION ANK & HALF SOLID STI
L2380 0 HCPCS / CPT® TORSION STRAIGHT KNEE JOINT
L2385 0 HCPCS / CPT® STRAIGHT KNEE JOINT HEAVY DU
L2387 0 HCPCS / CPT® ADD LE POLY KNEE CUSTOM KAFO
L2390 0 HCPCS / CPT® OFFSET KNEE JOINT EACH
L2395 0 HCPCS / CPT® OFFSET KNEE JOINT HEAVY DUTY
L2397 0 HCPCS / CPT® SUSPENSION SLEEVE LOWER EXT
L2405 0 HCPCS / CPT® KNEE JOINT DROP LOCK EA JNT
L2415 0 HCPCS / CPT® KNEE JOINT CAM LOCK EACH JOI
L2425 0 HCPCS / CPT® KNEE DISC/DIAL LOCK/ADJ FLEX
L2430 0 HCPCS / CPT® KNEE JNT RATCHET LOCK EA JNT
L2492 0 HCPCS / CPT® KNEE LIFT LOOP DROP LOCK RIN
L2500 0 HCPCS / CPT® THI/GLUT/ISCHIA WGT BEARING
L2510 0 HCPCS / CPT® TH/WGHT BEAR QUAD-LAT BRIM M
L2520 0 HCPCS / CPT® TH/WGHT BEAR QUAD-LAT BRIM C
L2525 0 HCPCS / CPT® TH/WGHT BEAR NAR M-L BRIM MO
L2526 0 HCPCS / CPT® TH/WGHT BEAR NAR M-L BRIM CU
L2530 0 HCPCS / CPT® THIGH/WGHT BEAR LACER NON-MO
L2540 0 HCPCS / CPT® THIGH/WGHT BEAR LACER MOLDED
L2550 0 HCPCS / CPT® THIGH/WGHT BEAR HIGH ROLL CU
L2570 0 HCPCS / CPT® HIP CLEVIS TYPE 2 POSIT JNT
L2580 0 HCPCS / CPT® PELVIC CONTROL PELVIC SLING
L2600 0 HCPCS / CPT® HIP CLEVIS/THRUST BEARING FR
L2610 0 HCPCS / CPT® HIP CLEVIS/THRUST BEARING LO
L2620 0 HCPCS / CPT® PELVIC CONTROL HIP HEAVY DUT
L2622 0 HCPCS / CPT® HIP JOINT ADJUSTABLE FLEXION
L2624 0 HCPCS / CPT® HIP ADJ FLEX EXT ABDUCT CONT
L2627 0 HCPCS / CPT® PLASTIC MOLD RECIPRO HIP & C
L2628 0 HCPCS / CPT® METAL FRAME RECIPRO HIP & CA
L2630 0 HCPCS / CPT® PELVIC CONTROL BAND & BELT U
L2640 0 HCPCS / CPT® PELVIC CONTROL BAND & BELT B
L2650 0 HCPCS / CPT® PELV & THOR CONTROL GLUTEAL
L2660 0 HCPCS / CPT® THORACIC CONTROL THORACIC BA
L2670 0 HCPCS / CPT® THORAC CONT PARASPINAL UPRIG
L2680 0 HCPCS / CPT® THORAC CONT LAT SUPPORT UPRI
L2750 0 HCPCS / CPT® PLATING CHROME/NICKEL PR BAR
L2755 0 HCPCS / CPT® CARBON GRAPHITE LAMINATION
L2760 0 HCPCS / CPT® EXTENSION PER EXTENSION PER
L2768 0 HCPCS / CPT® ORTHO SIDEBAR DISCONNECT
L2780 0 HCPCS / CPT® NON-CORROSIVE FINISH
L2785 0 HCPCS / CPT® DROP LOCK RETAINER EACH
L2795 0 HCPCS / CPT® KNEE CONTROL FULL KNEECAP
L2800 0 HCPCS / CPT® KNEE CAP MEDIAL OR LATERAL P
L2810 0 HCPCS / CPT® KNEE CONTROL CONDYLAR PAD
L2820 0 HCPCS / CPT® SOFT INTERFACE BELOW KNEE SE
L2830 0 HCPCS / CPT® SOFT INTERFACE ABOVE KNEE SE
L2840 0 HCPCS / CPT® TIBIAL LENGTH SOCK FX OR EQU
L2850 0 HCPCS / CPT® FEMORAL LGTH SOCK FX OR EQUA
L2861 0 HCPCS / CPT® TORSION MECHANISM KNEE/ANKLE
L2999 0 HCPCS / CPT® LOWER EXTREMITY ORTHOSIS NOS
L3000 0 HCPCS / CPT® FT INSERT UCB BERKELEY SHELL
L3001 0 HCPCS / CPT® FOOT INSERT REMOV MOLDED SPE
L3002 0 HCPCS / CPT® FOOT INSERT PLASTAZOTE OR EQ
L3003 0 HCPCS / CPT® FOOT INSERT SILICONE GEL EAC
L3010 0 HCPCS / CPT® FOOT LONGITUDINAL ARCH SUPPO
L3020 0 HCPCS / CPT® FOOT LONGITUD/METATARSAL SUP
L3030 0 HCPCS / CPT® FOOT ARCH SUPPORT REMOV PREM
L3031 0 HCPCS / CPT® FOOT LAMIN/PREPREG COMPOSITE
L3040 0 HCPCS / CPT® FT ARCH SUPRT PREMOLD LONGIT
L3050 0 HCPCS / CPT® FOOT ARCH SUPP PREMOLD METAT
L3060 0 HCPCS / CPT® FOOT ARCH SUPP LONGITUD/META
L3070 0 HCPCS / CPT® ARCH SUPRT ATT TO SHO LONGIT
L3080 0 HCPCS / CPT® ARCH SUPP ATT TO SHOE METATA
L3090 0 HCPCS / CPT® ARCH SUPP ATT TO SHOE LONG/M
L3100 0 HCPCS / CPT® HALLUS-VALGUS NT DYN PRE OTS
L3140 0 HCPCS / CPT® ABDUCTION ROTATION BAR SHOE
L3150 0 HCPCS / CPT® ABDUCT ROTATION BAR W/O SHOE
L3160 0 HCPCS / CPT® SHOE STYLED POSITIONING DEV
L3170 0 HCPCS / CPT® FOOT PLAS HEEL STABI PRE OTS
L3201 0 HCPCS / CPT® OXFORD W SUPINAT/PRONAT INF
L3202 0 HCPCS / CPT® OXFORD W/ SUPINAT/PRONATOR C
L3203 0 HCPCS / CPT® OXFORD W/ SUPINATOR/PRONATOR
L3204 0 HCPCS / CPT® HIGHTOP W/ SUPP/PRONATOR INF
L3206 0 HCPCS / CPT® HIGHTOP W/ SUPP/PRONATOR CHI
L3207 0 HCPCS / CPT® HIGHTOP W/ SUPP/PRONATOR JUN
L3208 0 HCPCS / CPT® SURGICAL BOOT EACH INFANT
L3209 0 HCPCS / CPT® SURGICAL BOOT EACH CHILD
L3211 0 HCPCS / CPT® SURGICAL BOOT EACH JUNIOR
L3212 0 HCPCS / CPT® BENESCH BOOT PAIR INFANT
L3213 0 HCPCS / CPT® BENESCH BOOT PAIR CHILD
L3214 0 HCPCS / CPT® BENESCH BOOT PAIR JUNIOR
L3215 0 HCPCS / CPT® ORTHOPEDIC FTWEAR LADIES OXF
L3216 0 HCPCS / CPT® ORTHOPED LADIES SHOES DPTH I
L3217 0 HCPCS / CPT® LADIES SHOES HIGHTOP DEPTH I
L3219 0 HCPCS / CPT® ORTHOPEDIC MENS SHOES OXFORD
L3221 0 HCPCS / CPT® ORTHOPEDIC MENS SHOES DPTH I
L3222 0 HCPCS / CPT® MENS SHOES HIGHTOP DEPTH INL
L3224 0 HCPCS / CPT® WOMAN’S SHOE OXFORD BRACE
L3225 0 HCPCS / CPT® MAN’S SHOE OXFORD BRACE
L3230 0 HCPCS / CPT® CUSTOM SHOES DEPTH INLAY
L3250 0 HCPCS / CPT® CUSTOM MOLD SHOE REMOV PROST
L3251 0 HCPCS / CPT® SHOE MOLDED TO PT SILICONE S
L3252 0 HCPCS / CPT® SHOE MOLDED PLASTAZOTE CUST
L3253 0 HCPCS / CPT® SHOE MOLDED PLASTAZOTE CUST
L3254 0 HCPCS / CPT® ORTH FOOT NON-STNDARD SIZE/W
L3255 0 HCPCS / CPT® ORTH FOOT NON-STANDARD SIZE/
L3257 0 HCPCS / CPT® ORTH FOOT ADD CHARGE SPLIT S
L3260 79 HCPCS / CPT® AMBULATORY SURGICAL BOOT EAC
L3265 0 HCPCS / CPT® PLASTAZOTE SANDAL EACH
L3300 0 HCPCS / CPT® SHO LIFT TAPER TO METATARSAL
L3310 0 HCPCS / CPT® SHOE LIFT ELEV HEEL/SOLE NEO
L3320 0 HCPCS / CPT® SHOE LIFT ELEV HEEL/SOLE COR
L3330 0 HCPCS / CPT® LIFTS ELEVATION METAL EXTENS
L3332 0 HCPCS / CPT® SHOE LIFTS TAPERED TO ONE-HA
L3334 0 HCPCS / CPT® SHOE LIFTS ELEVATION HEEL /I
L3340 0 HCPCS / CPT® SHOE WEDGE SACH
L3350 0 HCPCS / CPT® SHOE HEEL WEDGE
L3360 0 HCPCS / CPT® SHOE SOLE WEDGE OUTSIDE SOLE
L3370 0 HCPCS / CPT® SHOE SOLE WEDGE BETWEEN SOLE
L3380 0 HCPCS / CPT® SHOE CLUBFOOT WEDGE
L3390 0 HCPCS / CPT® SHOE OUTFLARE WEDGE
L3400 0 HCPCS / CPT® SHOE METATARSAL BAR WEDGE RO
L3410 0 HCPCS / CPT® SHOE METATARSAL BAR BETWEEN
L3420 0 HCPCS / CPT® FULL SOLE/HEEL WEDGE BTWEEN
L3430 0 HCPCS / CPT® SHO HEEL COUNT PLAST REINFOR
L3440 0 HCPCS / CPT® HEEL LEATHER REINFORCED
L3450 0 HCPCS / CPT® SHOE HEEL SACH CUSHION TYPE
L3455 0 HCPCS / CPT® SHOE HEEL NEW LEATHER STANDA
L3460 0 HCPCS / CPT® SHOE HEEL NEW RUBBER STANDAR
L3465 0 HCPCS / CPT® SHOE HEEL THOMAS WITH WEDGE
L3470 0 HCPCS / CPT® SHOE HEEL THOMAS EXTEND TO B
L3480 0 HCPCS / CPT® SHOE HEEL PAD & DEPRESS FOR
L3485 0 HCPCS / CPT® SHOE HEEL PAD REMOVABLE FOR
L3500 0 HCPCS / CPT® ORTHO SHOE ADD LEATHER INSOL
L3510 0 HCPCS / CPT® ORTHOPEDIC SHOE ADD RUB INSL
L3520 0 HCPCS / CPT® O SHOE ADD FELT W LEATH INSL
L3530 0 HCPCS / CPT® ORTHO SHOE ADD HALF SOLE
L3540 0 HCPCS / CPT® ORTHO SHOE ADD FULL SOLE
L3550 0 HCPCS / CPT® O SHOE ADD STANDARD TOE TAP
L3560 0 HCPCS / CPT® O SHOE ADD HORSESHOE TOE TAP
L3570 0 HCPCS / CPT® O SHOE ADD INSTEP EXTENSION
L3580 0 HCPCS / CPT® O SHOE ADD INSTEP VELCRO CLO
L3590 0 HCPCS / CPT® O SHOE CONVERT TO SOF COUNTE
L3595 0 HCPCS / CPT® ORTHO SHOE ADD MARCH BAR
L3600 0 HCPCS / CPT® TRANS SHOE CALIP PLATE EXIST
L3610 0 HCPCS / CPT® TRANS SHOE CALIPER PLATE NEW
L3620 0 HCPCS / CPT® TRANS SHOE SOLID STIRRUP EXI
L3630 0 HCPCS / CPT® TRANS SHOE SOLID STIRRUP NEW
L3640 0 HCPCS / CPT® SHOE DENNIS BROWNE SPLINT BO
L3649 0 HCPCS / CPT® ORTHOPEDIC SHOE MODIFICA NOS
L3650 0 HCPCS / CPT® SO 8 ABD RESTRAINT PRE OTS
L3660 0 HCPCS / CPT® SO 8 AB RSTR CAN/WEB PRE OTS
L3670 0 HCPCS / CPT® SO ACRO/CLAV CAN WEB PRE OTS
L3671 0 HCPCS / CPT® SO CAP DESIGN W/O JNTS CF
L3674 0 HCPCS / CPT® SO AIRPLANE W/WO JOINT CF
L3675 0 HCPCS / CPT® SO VEST CANVAS/WEB PRE OTS
L3677 0 HCPCS / CPT® SO HARD PLAS STABILI PRE CST
L3678 0 HCPCS / CPT® SO HARD PLAS STABILI PRE OTS
L3702 0 HCPCS / CPT® EO W/O JOINTS CF
L3710 0 HCPCS / CPT® EO ELAS W/METAL JNTS PRE OTS
L3720 0 HCPCS / CPT® FOREARM/ARM CUFFS FREE MOTIO
L3730 0 HCPCS / CPT® FOREARM/ARM CUFFS EXT/FLEX A
L3740 0 HCPCS / CPT® CUFFS ADJ LOCK W/ ACTIVE CON
L3760 0 HCPCS / CPT® EO WITHJOINT, PREFABRICATED
L3762 0 HCPCS / CPT® EO RIGID W/O JOINTS PRE OTS
L3763 0 HCPCS / CPT® EWHO RIGID W/O JNTS CF
L3764 0 HCPCS / CPT® EWHO W/JOINT(S) CF
L3765 0 HCPCS / CPT® EWHFO RIGID W/O JNTS CF
L3766 0 HCPCS / CPT® EWHFO W/JOINT(S) CF
L3806 0 HCPCS / CPT® WHFO W/JOINT(S) CUSTOM FAB
L3807 0 HCPCS / CPT® WHFO W/O JOINTS PRE CST
L3808 0 HCPCS / CPT® WHFO, RIGID W/O JOINTS
L3809 0 HCPCS / CPT® WHFO W/O JOINTS PRE OTS
L3891 0 HCPCS / CPT® TORSION MECHANISM WRIST/ELBO
L3900 0 HCPCS / CPT® HINGE EXTENSION/FLEX WRIST/F
L3901 0 HCPCS / CPT® HINGE EXT/FLEX WRIST FINGER
L3904 0 HCPCS / CPT® WHFO ELECTRIC CUSTOM FITTED
L3905 0 HCPCS / CPT® WHO W/NONTORSION JNT(S) CF
L3906 0 HCPCS / CPT® WHO W/O JOINTS CF
L3908 79 HCPCS / CPT® WHO COCK-UP NONMOLDE PRE OTS
L3912 0 HCPCS / CPT® HFO FLEXION GLOVE PRE OTS
L3913 0 HCPCS / CPT® HFO W/O JOINTS CF
L3915 0 HCPCS / CPT® WHO NONTORSION JNTS PRE CST
L3916 0 HCPCS / CPT® WHO NONTORSION JNTS PRE OTS
L3917 0 HCPCS / CPT® METACARP FX ORTHOSIS PRE CST
L3918 0 HCPCS / CPT® METACARP FX ORTHOSIS PRE OTS
L3919 0 HCPCS / CPT® HO W/O JOINTS CF
L3921 0 HCPCS / CPT® HFO W/JOINT(S) CF
L3923 0 HCPCS / CPT® HFO WITHOUT JOINTS PRE CST
L3924 0 HCPCS / CPT® HFO WITHOUT JOINTS PRE OTS
L3925 0 HCPCS / CPT® FO PIP DIP JNT/SPRNG PRE OTS
L3927 0 HCPCS / CPT® FO PIP DIP NO JT SPR PRE OTS
L3929 0 HCPCS / CPT® HFO NONTORSION JNTS PRE CST
L3930 0 HCPCS / CPT® HFO NONTORSION JNTS PRE OTS
L3931 0 HCPCS / CPT® WHFO NONTORSION JOINT PREFAB
L3933 0 HCPCS / CPT® FO W/O JOINTS CF
L3935 0 HCPCS / CPT® FO NONTORSION JOINT CF
L3956 0 HCPCS / CPT® ADD JOINT UPPER EXT ORTHOSIS
L3960 0 HCPCS / CPT® SEWHO AIRPLAN DESIG ABDU POS
L3961 0 HCPCS / CPT® SEWHO CAP DESIGN W/O JNTS CF
L3962 0 HCPCS / CPT® SEWHO ERBS PALSEY DESIGN ABD
L3967 0 HCPCS / CPT® SEWHO AIRPLANE W/O JNTS CF
L3971 0 HCPCS / CPT® SEWHO CAP DESIGN W/JNT(S) CF
L3973 0 HCPCS / CPT® SEWHO AIRPLANE W/JNT(S) CF
L3975 0 HCPCS / CPT® SEWHFO CAP DESIGN W/O JNT CF
L3976 0 HCPCS / CPT® SEWHFO AIRPLANE W/O JNTS CF
L3977 0 HCPCS / CPT® SEWHFO CAP DESGN W/JNT(S) CF
L3978 0 HCPCS / CPT® SEWHFO AIRPLANE W/JNT(S) CF
L3980 0 HCPCS / CPT® UP EXT FX ORTHOS HUMERAL NOS
L3981 0 HCPCS / CPT® UE FX ORTH SHOUL CAP FOREARM
L3982 0 HCPCS / CPT® UPPER EXT FX ORTHOSIS RAD/UL
L3984 0 HCPCS / CPT® UPPER EXT FX ORTHOSIS WRIST
L3995 0 HCPCS / CPT® SOCK FRACTURE OR EQUAL EACH
L3999 0 HCPCS / CPT® UPPER LIMB ORTHOSIS NOS
L4000 0 HCPCS / CPT® REPL GIRDLE MILWAUKEE ORTH
L4002 0 HCPCS / CPT® REPLACE STRAP, ANY ORTHOSIS
L4010 0 HCPCS / CPT® REPLACE TRILATERAL SOCKET BR
L4020 0 HCPCS / CPT® REPLACE QUADLAT SOCKET BRIM
L4030 0 HCPCS / CPT® REPLACE SOCKET BRIM CUST FIT
L4040 0 HCPCS / CPT® REPLACE MOLDED THIGH LACER
L4045 0 HCPCS / CPT® REPLACE NON-MOLDED THIGH LAC
L4050 0 HCPCS / CPT® REPLACE MOLDED CALF LACER
L4055 0 HCPCS / CPT® REPLACE NON-MOLDED CALF LACE
L4060 0 HCPCS / CPT® REPLACE HIGH ROLL CUFF
L4070 0 HCPCS / CPT® REPLACE PROX & DIST UPRIGHT
L4080 0 HCPCS / CPT® REPL MET BAND KAFO-AFO PROX
L4090 0 HCPCS / CPT® REPL MET BAND KAFO-AFO CALF/
L4100 0 HCPCS / CPT® REPL LEATH CUFF KAFO PROX TH
L4110 0 HCPCS / CPT® REPL LEATH CUFF KAFO-AFO CAL
L4130 0 HCPCS / CPT® REPLACE PRETIBIAL SHELL
L4205 0 HCPCS / CPT® ORTHO DVC REPAIR PER 15 MIN
L4210 0 HCPCS / CPT® ORTH DEV REPAIR/REPL MINOR P
L4350 412 HCPCS / CPT® ANKLE CONTROL ORTHO PRE OTS
L4360 106 HCPCS / CPT® PNEUMAT WALKING BOOT PRE CST
L4361 0 HCPCS / CPT® PNEUMA/VAC WALK BOOT PRE OTS
L4370 0 HCPCS / CPT® PNEUM FULL LEG SPLNT PRE OTS
L4380 114 HCPCS / CPT® PNEUMATIC KNEE SPLINT
L4386 153 HCPCS / CPT® NON-PNEUM WALK BOOT PRE CST
L4387 0 HCPCS / CPT® NON-PNEUM WALK BOOT PRE OTS
L4392 0 HCPCS / CPT® REPLACE AFO SOFT INTERFACE
L4394 0 HCPCS / CPT® REPLACE FOOT DROP SPINT
L4396 0 HCPCS / CPT® STATIC OR DYNAMI AFO PRE CST
L4397 0 HCPCS / CPT® STATIC OR DYNAMI AFO PRE OTS
L4398 0 HCPCS / CPT® FOOT DROP SPLINT PRE OTS
L4631 0 HCPCS / CPT® AFO, WALK BOOT TYPE, CUS FAB
L5000 0 HCPCS / CPT® SHO INSERT W ARCH TOE FILLER
L5010 0 HCPCS / CPT® MOLD SOCKET ANK HGT W/ TOE F
L5020 0 HCPCS / CPT® TIBIAL TUBERCLE HGT W/ TOE F
L5050 0 HCPCS / CPT® ANK SYMES MOLD SCKT SACH FT
L5060 0 HCPCS / CPT® SYMES MET FR LEATH SOCKET AR
L5100 0 HCPCS / CPT® MOLDED SOCKET SHIN SACH FOOT
L5105 0 HCPCS / CPT® PLAST SOCKET JTS/THGH LACER
L5150 0 HCPCS / CPT® MOLD SCKT EXT KNEE SHIN SACH
L5160 0 HCPCS / CPT® MOLD SOCKET BENT KNEE SHIN S
L5200 0 HCPCS / CPT® KNE SING AXIS FRIC SHIN SACH
L5210 0 HCPCS / CPT® NO KNEE/ANKLE JOINTS W/ FT B
L5220 0 HCPCS / CPT® NO KNEE JOINT WITH ARTIC ALI
L5230 0 HCPCS / CPT® FEM FOCAL DEFIC CONSTANT FRI
L5250 0 HCPCS / CPT® HIP CANAD SING AXI CONS FRIC
L5270 0 HCPCS / CPT® TILT TABLE LOCKING HIP SING
L5280 0 HCPCS / CPT® HEMIPELVECT CANAD SING AXIS
L5301 0 HCPCS / CPT® BK MOLD SOCKET SACH FT ENDO
L5312 0 HCPCS / CPT® KNEE DISART, SACH FT, ENDO
L5321 0 HCPCS / CPT® AK OPEN END SACH
L5331 0 HCPCS / CPT® HIP DISART CANADIAN SACH FT
L5341 0 HCPCS / CPT® HEMIPELVECTOMY CANADIAN SACH
L5400 0 HCPCS / CPT® POSTOP DRESS & 1 CAST CHG BK
L5410 0 HCPCS / CPT® POSTOP DSG BK EA ADD CAST CH
L5420 0 HCPCS / CPT® POSTOP DSG & 1 CAST CHG AK/D
L5430 0 HCPCS / CPT® POSTOP DSG AK EA ADD CAST CH
L5450 0 HCPCS / CPT® POSTOP APP NON-WGT BEAR DSG
L5460 0 HCPCS / CPT® POSTOP APP NON-WGT BEAR DSG
L5500 0 HCPCS / CPT® INIT BK PTB PLASTER DIRECT
L5505 0 HCPCS / CPT® INIT AK ISCHAL PLSTR DIRECT
L5510 0 HCPCS / CPT® PREP BK PTB PLASTER MOLDED
L5520 0 HCPCS / CPT® PERP BK PTB THERMOPLS DIRECT
L5530 0 HCPCS / CPT® PREP BK PTB THERMOPLS MOLDED
L5535 0 HCPCS / CPT® PREP BK PTB OPEN END SOCKET
L5540 0 HCPCS / CPT® PREP BK PTB LAMINATED SOCKET
L5560 0 HCPCS / CPT® PREP AK ISCHIAL PLAST MOLDED
L5570 0 HCPCS / CPT® PREP AK ISCHIAL DIRECT FORM
L5580 0 HCPCS / CPT® PREP AK ISCHIAL THERMO MOLD
L5585 0 HCPCS / CPT® PREP AK ISCHIAL OPEN END
L5590 0 HCPCS / CPT® PREP AK ISCHIAL LAMINATED
L5595 0 HCPCS / CPT® HIP DISARTIC SACH THERMOPLS
L5600 0 HCPCS / CPT® HIP DISART SACH LAMINAT MOLD
L5610 0 HCPCS / CPT® ABOVE KNEE HYDRACADENCE
L5611 0 HCPCS / CPT® AK 4 BAR LINK W/FRIC SWING
L5613 0 HCPCS / CPT® AK 4 BAR LING W/HYDRAUL SWIG
L5614 0 HCPCS / CPT® 4-BAR LINK ABOVE KNEE W/SWNG
L5616 0 HCPCS / CPT® AK UNIV MULTIPLEX SYS FRICT
L5617 0 HCPCS / CPT® AK/BK SELF-ALIGNING UNIT EA
L5618 0 HCPCS / CPT® TEST SOCKET SYMES
L5620 0 HCPCS / CPT® TEST SOCKET BELOW KNEE
L5622 0 HCPCS / CPT® TEST SOCKET KNEE DISARTICULA
L5624 0 HCPCS / CPT® TEST SOCKET ABOVE KNEE
L5626 0 HCPCS / CPT® TEST SOCKET HIP DISARTICULAT
L5628 0 HCPCS / CPT® TEST SOCKET HEMIPELVECTOMY
L5629 0 HCPCS / CPT® BELOW KNEE ACRYLIC SOCKET
L5630 0 HCPCS / CPT® SYME TYP EXPANDABL WALL SCKT
L5631 0 HCPCS / CPT® AK/KNEE DISARTIC ACRYLIC SOC
L5632 0 HCPCS / CPT® SYMES TYPE PTB BRIM DESIGN S
L5634 0 HCPCS / CPT® SYMES TYPE POSTER OPENING SO
L5636 0 HCPCS / CPT® SYMES TYPE MEDIAL OPENING SO
L5637 0 HCPCS / CPT® BELOW KNEE TOTAL CONTACT
L5638 0 HCPCS / CPT® BELOW KNEE LEATHER SOCKET
L5639 0 HCPCS / CPT® BELOW KNEE WOOD SOCKET
L5640 0 HCPCS / CPT® KNEE DISARTICULAT LEATHER SO
L5642 0 HCPCS / CPT® ABOVE KNEE LEATHER SOCKET
L5643 0 HCPCS / CPT® HIP FLEX INNER SOCKET EXT FR
L5644 0 HCPCS / CPT® ABOVE KNEE WOOD SOCKET
L5645 0 HCPCS / CPT® BK FLEX INNER SOCKET EXT FRA
L5646 0 HCPCS / CPT® BELOW KNEE CUSHION SOCKET
L5647 0 HCPCS / CPT® BELOW KNEE SUCTION SOCKET
L5648 0 HCPCS / CPT® ABOVE KNEE CUSHION SOCKET
L5649 0 HCPCS / CPT® ISCH CONTAINMT/NARROW M-L SO
L5650 0 HCPCS / CPT® TOT CONTACT AK/KNEE DISART S
L5651 0 HCPCS / CPT® AK FLEX INNER SOCKET EXT FRA
L5652 0 HCPCS / CPT® SUCTION SUSP AK/KNEE DISART
L5653 0 HCPCS / CPT® KNEE DISART EXPAND WALL SOCK
L5654 0 HCPCS / CPT® SOCKET INSERT SYMES
L5655 0 HCPCS / CPT® SOCKET INSERT BELOW KNEE
L5656 0 HCPCS / CPT® SOCKET INSERT KNEE ARTICULAT
L5658 0 HCPCS / CPT® SOCKET INSERT ABOVE KNEE
L5661 0 HCPCS / CPT® MULTI-DUROMETER SYMES
L5665 0 HCPCS / CPT® MULTI-DUROMETER BELOW KNEE
L5666 0 HCPCS / CPT® BELOW KNEE CUFF SUSPENSION
L5668 0 HCPCS / CPT® BK MOLDED DISTAL CUSHION
L5670 0 HCPCS / CPT® BK MOLDED SUPRACONDYLAR SUSP
L5671 0 HCPCS / CPT® BK/AK LOCKING MECHANISM
L5672 0 HCPCS / CPT® BK REMOVABLE MEDIAL BRIM SUS
L5673 0 HCPCS / CPT® SOCKET INSERT W LOCK MECH
L5676 0 HCPCS / CPT® BK KNEE JOINTS SINGLE AXIS P
L5677 0 HCPCS / CPT® BK KNEE JOINTS POLYCENTRIC P
L5678 0 HCPCS / CPT® BK JOINT COVERS PAIR
L5679 0 HCPCS / CPT® SOCKET INSERT W/O LOCK MECH
L5680 0 HCPCS / CPT® BK THIGH LACER NON-MOLDED
L5681 0 HCPCS / CPT® INTL CUSTM CONG/LATYP INSERT
L5682 0 HCPCS / CPT® BK THIGH LACER GLUT/ISCHIA M
L5683 0 HCPCS / CPT® INITIAL CUSTOM SOCKET INSERT
L5684 0 HCPCS / CPT® BK FORK STRAP
L5685 0 HCPCS / CPT® BELOW KNEE SUS/SEAL SLEEVE
L5686 0 HCPCS / CPT® BK BACK CHECK
L5688 0 HCPCS / CPT® BK WAIST BELT WEBBING
L5690 0 HCPCS / CPT® BK WAIST BELT PADDED AND LIN
L5692 0 HCPCS / CPT® AK PELVIC CONTROL BELT LIGHT
L5694 0 HCPCS / CPT® AK PELVIC CONTROL BELT PAD/L
L5695 0 HCPCS / CPT® AK SLEEVE SUSP NEOPRENE/EQUA
L5696 0 HCPCS / CPT® AK/KNEE DISARTIC PELVIC JOIN
L5697 0 HCPCS / CPT® AK/KNEE DISARTIC PELVIC BAND
L5698 0 HCPCS / CPT® AK/KNEE DISARTIC SILESIAN BA
L5699 0 HCPCS / CPT® SHOULDER HARNESS
L5700 0 HCPCS / CPT® REPLACE SOCKET BELOW KNEE
L5701 0 HCPCS / CPT® REPLACE SOCKET ABOVE KNEE
L5702 0 HCPCS / CPT® REPLACE SOCKET HIP
L5703 0 HCPCS / CPT® SYMES ANKLE W/O (SACH) FOOT
L5704 0 HCPCS / CPT® CUSTOM SHAPE COVER BK
L5705 0 HCPCS / CPT® CUSTOM SHAPE COVER AK
L5706 0 HCPCS / CPT® CUSTOM SHAPE CVR KNEE DISART
L5707 0 HCPCS / CPT® CUSTOM SHAPE CVR HIP DISART
L5710 0 HCPCS / CPT® KNE-SHIN EXO SNG AXI MNL LOC
L5711 0 HCPCS / CPT® KNEE-SHIN EXO MNL LOCK ULTRA
L5712 0 HCPCS / CPT® KNEE-SHIN EXO FRICT SWG & ST
L5714 0 HCPCS / CPT® KNEE-SHIN EXO VARIABLE FRICT
L5716 0 HCPCS / CPT® KNEE-SHIN EXO MECH STANCE PH
L5718 0 HCPCS / CPT® KNEE-SHIN EXO FRCT SWG & STA
L5722 0 HCPCS / CPT® KNEE-SHIN PNEUM SWG FRCT EXO
L5724 0 HCPCS / CPT® KNEE-SHIN EXO FLUID SWING PH
L5726 0 HCPCS / CPT® KNEE-SHIN EXT JNTS FLD SWG E
L5728 0 HCPCS / CPT® KNEE-SHIN FLUID SWG & STANCE
L5780 0 HCPCS / CPT® KNEE-SHIN PNEUM/HYDRA PNEUM
L5781 0 HCPCS / CPT® LOWER LIMB PROS VACUUM PUMP
L5782 0 HCPCS / CPT® HD LOW LIMB PROS VACUUM PUMP
L5785 0 HCPCS / CPT® EXOSKELETAL BK ULTRALT MATER
L5790 0 HCPCS / CPT® EXOSKELETAL AK ULTRA-LIGHT M
L5795 0 HCPCS / CPT® EXOSKEL HIP ULTRA-LIGHT MATE
L5810 0 HCPCS / CPT® ENDOSKEL KNEE-SHIN MNL LOCK
L5811 0 HCPCS / CPT® ENDO KNEE-SHIN MNL LCK ULTRA
L5812 0 HCPCS / CPT® ENDO KNEE-SHIN FRCT SWG & ST
L5814 0 HCPCS / CPT® ENDO KNEE-SHIN HYDRAL SWG PH
L5816 0 HCPCS / CPT® ENDO KNEE-SHIN POLYC MCH STA
L5818 0 HCPCS / CPT® ENDO KNEE-SHIN FRCT SWG & ST
L5822 0 HCPCS / CPT® ENDO KNEE-SHIN PNEUM SWG FRC
L5824 0 HCPCS / CPT® ENDO KNEE-SHIN FLUID SWING P
L5826 0 HCPCS / CPT® MINIATURE KNEE JOINT
L5828 0 HCPCS / CPT® ENDO KNEE-SHIN FLUID SWG/STA
L5830 0 HCPCS / CPT® ENDO KNEE-SHIN PNEUM/SWG PHA
L5840 0 HCPCS / CPT® MULTI-AXIAL KNEE/SHIN SYSTEM
L5845 0 HCPCS / CPT® KNEE-SHIN SYS STANCE FLEXION
L5848 0 HCPCS / CPT® KNEE-SHIN SYS HYDRAUL STANCE
L5850 0 HCPCS / CPT® ENDO AK/HIP KNEE EXTENS ASSI
L5855 0 HCPCS / CPT® MECH HIP EXTENSION ASSIST
L5856 0 HCPCS / CPT® ELEC KNEE-SHIN SWING/STANCE
L5857 0 HCPCS / CPT® ELEC KNEE-SHIN SWING ONLY
L5858 0 HCPCS / CPT® STANCE PHASE ONLY
L5859 0 HCPCS / CPT® KNEE-SHIN PRO FLEX/EXT CONT
L5910 0 HCPCS / CPT® ENDO BELOW KNEE ALIGNABLE SY
L5920 0 HCPCS / CPT® ENDO AK/HIP ALIGNABLE SYSTEM
L5925 0 HCPCS / CPT® ABOVE KNEE MANUAL LOCK
L5930 0 HCPCS / CPT® HIGH ACTIVITY KNEE FRAME
L5940 0 HCPCS / CPT® ENDO BK ULTRA-LIGHT MATERIAL
L5950 0 HCPCS / CPT® ENDO AK ULTRA-LIGHT MATERIAL
L5960 0 HCPCS / CPT® ENDO HIP ULTRA-LIGHT MATERIA
L5961 0 HCPCS / CPT® ENDO POLY HIP, PNEU/HYD/ROT
L5962 0 HCPCS / CPT® BELOW KNEE FLEX COVER SYSTEM
L5964 0 HCPCS / CPT® ABOVE KNEE FLEX COVER SYSTEM
L5966 0 HCPCS / CPT® HIP FLEXIBLE COVER SYSTEM
L5968 0 HCPCS / CPT® MULTIAXIAL ANKLE W DORSIFLEX
L5969 0 HCPCS / CPT® AK/FT POWER ASST INCL MOTORS
L5970 0 HCPCS / CPT® FOOT EXTERNAL KEEL SACH FOOT
L5971 0 HCPCS / CPT® SACH FOOT, REPLACEMENT
L5972 0 HCPCS / CPT® FLEXIBLE KEEL FOOT
L5973 0 HCPCS / CPT® ANK-FOOT SYS DORS-PLANT FLEX
L5974 0 HCPCS / CPT® FOOT SINGLE AXIS ANKLE/FOOT
L5975 0 HCPCS / CPT® COMBO ANKLE/FOOT PROSTHESIS
L5976 0 HCPCS / CPT® ENERGY STORING FOOT
L5978 0 HCPCS / CPT® FT PROSTH MULTIAXIAL ANKL/FT
L5979 0 HCPCS / CPT® MULTI-AXIAL ANKLE/FT PROSTH
L5980 0 HCPCS / CPT® FLEX FOOT SYSTEM
L5981 0 HCPCS / CPT® FLEX-WALK SYS LOW EXT PROSTH
L5982 0 HCPCS / CPT® EXOSKELETAL AXIAL ROTATION U
L5984 0 HCPCS / CPT® ENDOSKELETAL AXIAL ROTATION
L5985 0 HCPCS / CPT® LWR EXT DYNAMIC PROSTH PYLON
L5986 0 HCPCS / CPT® MULTI-AXIAL ROTATION UNIT
L5987 0 HCPCS / CPT® SHANK FT W VERT LOAD PYLON
L5988 0 HCPCS / CPT® VERTICAL SHOCK REDUCING PYLO
L5990 0 HCPCS / CPT® USER ADJUSTABLE HEEL HEIGHT
L5999 0 HCPCS / CPT® LOWR EXTREMITY PROSTHES NOS
L6000 0 HCPCS / CPT® PART HAND THUMB REM
L6010 0 HCPCS / CPT® PART HAND LITTLE/RING
L6020 0 HCPCS / CPT® PART HAND NO FINGERS
L6026 0 HCPCS / CPT® PART HAND MYO EXCLU TERM DEV
L6050 0 HCPCS / CPT® WRST MLD SCK FLX HNG TRI PAD
L6055 0 HCPCS / CPT® WRST MOLD SOCK W/EXP INTERFA
L6100 0 HCPCS / CPT® ELB MOLD SOCK FLEX HINGE PAD
L6110 0 HCPCS / CPT® ELBOW MOLD SOCK SUSPENSION T
L6120 0 HCPCS / CPT® ELBOW MOLD DOUB SPLT SOC STE
L6130 0 HCPCS / CPT® ELBOW STUMP ACTIVATED LOCK H
L6200 0 HCPCS / CPT® ELBOW MOLD OUTSID LOCK HINGE
L6205 0 HCPCS / CPT® ELBOW MOLDED W/ EXPAND INTER
L6250 0 HCPCS / CPT® ELBOW INTER LOC ELBOW FORARM
L6300 0 HCPCS / CPT® SHLDER DISART INT LOCK ELBOW
L6310 0 HCPCS / CPT® SHOULDER PASSIVE RESTOR COMP
L6320 0 HCPCS / CPT® SHOULDER PASSIVE RESTOR CAP
L6350 0 HCPCS / CPT® THORACIC INTERN LOCK ELBOW
L6360 0 HCPCS / CPT® THORACIC PASSIVE RESTOR COMP
L6370 0 HCPCS / CPT® THORACIC PASSIVE RESTOR CAP
L6380 0 HCPCS / CPT® POSTOP DSG CAST CHG WRST/ELB
L6382 0 HCPCS / CPT® POSTOP DSG CAST CHG ELB DIS/
L6384 0 HCPCS / CPT® POSTOP DSG CAST CHG SHLDER/T
L6386 0 HCPCS / CPT® POSTOP EA CAST CHG & REALIGN
L6388 0 HCPCS / CPT® POSTOP APPLICAT RIGID DSG ON
L6400 0 HCPCS / CPT® BELOW ELBOW PROSTH TISS SHAP
L6450 0 HCPCS / CPT® ELB DISART PROSTH TISS SHAP
L6500 0 HCPCS / CPT® ABOVE ELBOW PROSTH TISS SHAP
L6550 0 HCPCS / CPT® SHLDR DISAR PROSTH TISS SHAP
L6570 0 HCPCS / CPT® SCAP THORAC PROSTH TISS SHAP
L6580 0 HCPCS / CPT® WRIST/ELBOW BOWDEN CABLE MOL
L6582 0 HCPCS / CPT® WRIST/ELBOW BOWDEN CBL DIR F
L6584 0 HCPCS / CPT® ELBOW FAIR LEAD CABLE MOLDED
L6586 0 HCPCS / CPT® ELBOW FAIR LEAD CABLE DIR FO
L6588 0 HCPCS / CPT® SHDR FAIR LEAD CABLE MOLDED
L6590 0 HCPCS / CPT® SHDR FAIR LEAD CABLE DIRECT
L6600 0 HCPCS / CPT® POLYCENTRIC HINGE PAIR
L6605 0 HCPCS / CPT® SINGLE PIVOT HINGE PAIR
L6610 0 HCPCS / CPT® FLEXIBLE METAL HINGE PAIR
L6611 0 HCPCS / CPT® ADDITIONAL SWITCH, EXT POWER
L6615 0 HCPCS / CPT® DISCONNECT LOCKING WRIST UNI
L6616 0 HCPCS / CPT® DISCONNECT INSERT LOCKING WR
L6620 0 HCPCS / CPT® FLEXION/EXTENSION WRIST UNIT
L6621 0 HCPCS / CPT® FLEX/EXT WRIST W/WO FRICTION
L6623 0 HCPCS / CPT® SPRING-ASS ROT WRST W/ LATCH
L6624 0 HCPCS / CPT® FLEX/EXT/ROTATION WRIST UNIT
L6625 0 HCPCS / CPT® ROTATION WRST W/ CABLE LOCK
L6628 0 HCPCS / CPT® QUICK DISCONN HOOK ADAPTER O
L6629 0 HCPCS / CPT® LAMINATION COLLAR W/ COUPLIN
L6630 0 HCPCS / CPT® STAINLESS STEEL ANY WRIST
L6632 0 HCPCS / CPT® LATEX SUSPENSION SLEEVE EACH
L6635 0 HCPCS / CPT® LIFT ASSIST FOR ELBOW
L6637 0 HCPCS / CPT® NUDGE CONTROL ELBOW LOCK
L6638 0 HCPCS / CPT® ELEC LOCK ON MANUAL PW ELBOW
L6640 0 HCPCS / CPT® SHOULDER ABDUCTION JOINT PAI
L6641 0 HCPCS / CPT® EXCURSION AMPLIFIER PULLEY T
L6642 0 HCPCS / CPT® EXCURSION AMPLIFIER LEVER TY
L6645 0 HCPCS / CPT® SHOULDER FLEXION-ABDUCTION J
L6646 0 HCPCS / CPT® MULTIPO LOCKING SHOULDER JNT
L6647 0 HCPCS / CPT® SHOULDER LOCK ACTUATOR
L6648 0 HCPCS / CPT® EXT PWRD SHLDER LOCK/UNLOCK
L6650 0 HCPCS / CPT® SHOULDER UNIVERSAL JOINT
L6655 0 HCPCS / CPT® STANDARD CONTROL CABLE EXTRA
L6660 0 HCPCS / CPT® HEAVY DUTY CONTROL CABLE
L6665 0 HCPCS / CPT® TEFLON OR EQUAL CABLE LINING
L6670 0 HCPCS / CPT® HOOK TO HAND CABLE ADAPTER
L6672 0 HCPCS / CPT® HARNESS CHEST/SHLDER SADDLE
L6675 0 HCPCS / CPT® HARNESS FIGURE OF 8 SING CON
L6676 0 HCPCS / CPT® HARNESS FIGURE OF 8 DUAL CON
L6677 0 HCPCS / CPT® UE TRIPLE CONTROL HARNESS
L6680 0 HCPCS / CPT® TEST SOCK WRIST DISART/BEL E
L6682 0 HCPCS / CPT® TEST SOCK ELBW DISART/ABOVE
L6684 0 HCPCS / CPT® TEST SOCKET SHLDR DISART/THO
L6686 0 HCPCS / CPT® SUCTION SOCKET
L6687 0 HCPCS / CPT® FRAME TYP SOCKET BEL ELBOW/W
L6688 0 HCPCS / CPT® FRAME TYP SOCK ABOVE ELB/DIS
L6689 0 HCPCS / CPT® FRAME TYP SOCKET SHOULDER DI
L6690 0 HCPCS / CPT® FRAME TYP SOCK INTERSCAP-THO
L6691 0 HCPCS / CPT® REMOVABLE INSERT EACH
L6692 0 HCPCS / CPT® SILICONE GEL INSERT OR EQUAL
L6693 0 HCPCS / CPT® LOCKINGELBOW FOREARM CNTRBAL
L6694 0 HCPCS / CPT® ELBOW SOCKET INS USE W/LOCK
L6695 0 HCPCS / CPT® ELBOW SOCKET INS USE W/O LCK
L6696 0 HCPCS / CPT® CUS ELBO SKT IN FOR CON/ATYP
L6697 0 HCPCS / CPT® CUS ELBO SKT IN NOT CON/ATYP
L6698 0 HCPCS / CPT® BELOW/ABOVE ELBOW LOCK MECH
L6703 0 HCPCS / CPT® TERM DEV, PASSIVE HAND MITT
L6704 0 HCPCS / CPT® TERM DEV, SPORT/REC/WORK ATT
L6706 0 HCPCS / CPT® TERM DEV MECH HOOK VOL OPEN
L6707 0 HCPCS / CPT® TERM DEV MECH HOOK VOL CLOSE
L6708 0 HCPCS / CPT® TERM DEV MECH HAND VOL OPEN
L6709 0 HCPCS / CPT® TERM DEV MECH HAND VOL CLOSE
L6711 0 HCPCS / CPT® PED TERM DEV, HOOK, VOL OPEN
L6712 0 HCPCS / CPT® PED TERM DEV, HOOK, VOL CLOS
L6713 0 HCPCS / CPT® PED TERM DEV, HAND, VOL OPEN
L6714 0 HCPCS / CPT® PED TERM DEV, HAND, VOL CLOS
L6715 0 HCPCS / CPT® TERM DEVICE, MULTI ART DIGIT
L6721 0 HCPCS / CPT® HOOK/HAND, HVY DTY, VOL OPEN
L6722 0 HCPCS / CPT® HOOK/HAND, HVY DTY, VOL CLOS
L6805 0 HCPCS / CPT® TERM DEV MODIFIER WRIST UNIT
L6810 0 HCPCS / CPT® TERM DEV PRECISION PINCH DEV
L6880 0 HCPCS / CPT® ELEC HAND IND ART DIGITS
L6881 0 HCPCS / CPT® TERM DEV AUTO GRASP FEATURE
L6882 0 HCPCS / CPT® MICROPROCESSOR CONTROL UPLMB
L6883 0 HCPCS / CPT® REPLC SOCKT BELOW E/W DISA
L6884 0 HCPCS / CPT® REPLC SOCKT ABOVE ELBOW DISA
L6885 0 HCPCS / CPT® REPLC SOCKT SHLDR DIS/INTERC
L6890 0 HCPCS / CPT® PREFAB GLOVE FOR TERM DEVICE
L6895 0 HCPCS / CPT® CUSTOM GLOVE FOR TERM DEVICE
L6900 0 HCPCS / CPT® HAND RESTORAT THUMB/1 FINGER
L6905 0 HCPCS / CPT® HAND RESTORATION MULTIPLE FI
L6910 0 HCPCS / CPT® HAND RESTORATION NO FINGERS
L6915 0 HCPCS / CPT® HAND RESTORATION REPLACMNT G
L6920 0 HCPCS / CPT® WRIST DISARTICUL SWITCH CTRL
L6925 0 HCPCS / CPT® WRIST DISART MYOELECTRONIC C
L6930 0 HCPCS / CPT® BELOW ELBOW SWITCH CONTROL
L6935 0 HCPCS / CPT® BELOW ELBOW MYOELECTRONIC CT
L6940 0 HCPCS / CPT® ELBOW DISARTICULATION SWITCH
L6945 0 HCPCS / CPT® ELBOW DISART MYOELECTRONIC C
L6950 0 HCPCS / CPT® ABOVE ELBOW SWITCH CONTROL
L6955 0 HCPCS / CPT® ABOVE ELBOW MYOELECTRONIC CT
L6960 0 HCPCS / CPT® SHLDR DISARTIC SWITCH CONTRO
L6965 0 HCPCS / CPT® SHLDR DISARTIC MYOELECTRONIC
L6970 0 HCPCS / CPT® INTERSCAPULAR-THOR SWITCH CT
L6975 0 HCPCS / CPT® INTERSCAP-THOR MYOELECTRONIC
L7007 0 HCPCS / CPT® ADULT ELECTRIC HAND
L7008 0 HCPCS / CPT® PEDIATRIC ELECTRIC HAND
L7009 0 HCPCS / CPT® ADULT ELECTRIC HOOK
L7040 0 HCPCS / CPT® PREHENSILE ACTUATOR
L7045 0 HCPCS / CPT® PEDIATRIC ELECTRIC HOOK
L7170 0 HCPCS / CPT® ELECTRONIC ELBOW HOSMER SWIT
L7180 0 HCPCS / CPT® ELECTRONIC ELBOW SEQUENTIAL
L7181 0 HCPCS / CPT® ELECTRONIC ELBO SIMULTANEOUS
L7185 0 HCPCS / CPT® ELECTRON ELBOW ADOLESCENT SW
L7186 0 HCPCS / CPT® ELECTRON ELBOW CHILD SWITCH
L7190 0 HCPCS / CPT® ELBOW ADOLESCENT MYOELECTRON
L7191 0 HCPCS / CPT® ELBOW CHILD MYOELECTRONIC CT
L7259 0 HCPCS / CPT® ELECTRONIC WRIST ROTATOR ANY
L7360 0 HCPCS / CPT® SIX VOLT BAT OTTO BOCK/EQ EA
L7362 0 HCPCS / CPT® BATTERY CHRGR SIX VOLT OTTO
L7364 0 HCPCS / CPT® TWELVE VOLT BATTERY UTAH/EQU
L7366 0 HCPCS / CPT® BATTERY CHRGR 12 VOLT UTAH/E
L7367 0 HCPCS / CPT® REPLACEMNT LITHIUM IONBATTER
L7368 0 HCPCS / CPT® LITHIUM ION BATTERY CHARGER
L7400 0 HCPCS / CPT® ADD UE PROST BE/WD, ULTLITE
L7401 0 HCPCS / CPT® ADD UE PROST A/E ULTLITE MAT
L7402 0 HCPCS / CPT® ADD UE PROST S/D ULTLITE MAT
L7403 0 HCPCS / CPT® ADD UE PROST B/E ACRYLIC
L7404 0 HCPCS / CPT® ADD UE PROST A/E ACRYLIC
L7405 0 HCPCS / CPT® ADD UE PROST S/D ACRYLIC
L7499 0 HCPCS / CPT® UPPER EXTREMITY PROSTHES NOS
L7510 0 HCPCS / CPT® PROSTHETIC DEVICE REPAIR REP
L7520 0 HCPCS / CPT® REPAIR PROSTHESIS PER 15 MIN
L7600 0 HCPCS / CPT® PROSTHETIC DONNING SLEEVE
L7900 0 HCPCS / CPT® MALE VACUUM ERECTION SYSTEM
L7902 0 HCPCS / CPT® TENSION RING, VAC ERECT DEV
L8000 0 HCPCS / CPT® MASTECTOMY BRA
L8001 0 HCPCS / CPT® BREAST PROSTHESIS BRA & FORM
L8002 0 HCPCS / CPT® BRST PRSTH BRA & BILAT FORM
L8010 0 HCPCS / CPT® MASTECTOMY SLEEVE
L8015 0 HCPCS / CPT® EXT BREASTPROSTHESIS GARMENT
L8020 0 HCPCS / CPT® MASTECTOMY FORM
L8030 0 HCPCS / CPT® BREAST PROSTHES W/O ADHESIVE
L8031 0 HCPCS / CPT® BREAST PROSTHESIS W ADHESIVE
L8032 0 HCPCS / CPT® REUSABLE NIPPLE PROSTHESIS
L8035 0 HCPCS / CPT® CUSTOM BREAST PROSTHESIS
L8039 0 HCPCS / CPT® BREAST PROSTHESIS NOS
L8040 0 HCPCS / CPT® NASAL PROSTHESIS
L8041 0 HCPCS / CPT® MIDFACIAL PROSTHESIS
L8042 0 HCPCS / CPT® ORBITAL PROSTHESIS
L8043 0 HCPCS / CPT® UPPER FACIAL PROSTHESIS
L8044 0 HCPCS / CPT® HEMI-FACIAL PROSTHESIS
L8045 0 HCPCS / CPT® AURICULAR PROSTHESIS
L8046 0 HCPCS / CPT® PARTIAL FACIAL PROSTHESIS
L8047 0 HCPCS / CPT® NASAL SEPTAL PROSTHESIS
L8048 0 HCPCS / CPT® UNSPEC MAXILLOFACIAL PROSTH
L8049 0 HCPCS / CPT® REPAIR MAXILLOFACIAL PROSTH
L8300 0 HCPCS / CPT® TRUSS SINGLE W/ STANDARD PAD
L8310 0 HCPCS / CPT® TRUSS DOUBLE W/ STANDARD PAD
L8320 0 HCPCS / CPT® TRUSS ADDITION TO STD PAD WA
L8330 0 HCPCS / CPT® TRUSS ADD TO STD PAD SCROTAL
L8400 0 HCPCS / CPT® SHEATH BELOW KNEE
L8410 0 HCPCS / CPT® SHEATH ABOVE KNEE
L8415 0 HCPCS / CPT® SHEATH UPPER LIMB
L8417 0 HCPCS / CPT® PROS SHEATH/SOCK W GEL CUSHN
L8420 0 HCPCS / CPT® PROSTHETIC SOCK MULTI PLY BK
L8430 0 HCPCS / CPT® PROSTHETIC SOCK MULTI PLY AK
L8435 0 HCPCS / CPT® PROS SOCK MULTI PLY UPPER LM
L8440 0 HCPCS / CPT® SHRINKER BELOW KNEE
L8460 0 HCPCS / CPT® SHRINKER ABOVE KNEE
L8465 0 HCPCS / CPT® SHRINKER UPPER LIMB
L8470 0 HCPCS / CPT® PROS SOCK SINGLE PLY BK
L8480 0 HCPCS / CPT® PROS SOCK SINGLE PLY AK
L8485 0 HCPCS / CPT® PROS SOCK SINGLE PLY UPPER L
L8499 0 HCPCS / CPT® UNLISTED MISC PROSTHETIC SER
L8500 0 HCPCS / CPT® ARTIFICIAL LARYNX
L8501 0 HCPCS / CPT® TRACHEOSTOMY SPEAKING VALVE
L8505 0 HCPCS / CPT® ARTIFICIAL LARYNX, ACCESSORY
L8507 0 HCPCS / CPT® TRACH-ESOPH VOICE PROS PT IN
L8509 0 HCPCS / CPT® TRACH-ESOPH VOICE PROS MD IN
L8510 0 HCPCS / CPT® VOICE AMPLIFIER
L8511 0 HCPCS / CPT® INDWELLING TRACH INSERT
L8512 0 HCPCS / CPT® GEL CAP FOR TRACH VOICE PROS
L8513 0 HCPCS / CPT® TRACH PROS CLEANING DEVICE
L8514 0 HCPCS / CPT® REPL TRACH PUNCTURE DILATOR
L8515 0 HCPCS / CPT® GEL CAP APP DEVICE FOR TRACH
L8600 0 HCPCS / CPT® IMPLANT BREAST SILICONE/EQ
L8603 0 HCPCS / CPT® COLLAGEN IMP URINARY 2.5 ML
L8604 0 HCPCS / CPT® DEXTRANOMER/HYALURONIC ACID
L8605 0 HCPCS / CPT® INJ BULKING AGENT ANAL CANAL
L8606 0 HCPCS / CPT® SYNTHETIC IMPLNT URINARY 1ML
L8607 0 HCPCS / CPT® INJ VOCAL CORD BULKING AGENT
L8609 0 HCPCS / CPT® ARTIFICIAL CORNEA
L8610 0 HCPCS / CPT® OCULAR IMPLANT
L8612 0 HCPCS / CPT® AQUEOUS SHUNT PROSTHESIS
L8613 0 HCPCS / CPT® OSSICULAR IMPLANT
L8614 0 HCPCS / CPT® COCHLEAR DEVICE
L8615 0 HCPCS / CPT® COCH IMPLANT HEADSET REPLACE
L8616 0 HCPCS / CPT® COCH IMPLANT MICROPHONE REPL
L8617 0 HCPCS / CPT® COCH IMPLANT TRANS COIL REPL
L8618 0 HCPCS / CPT® COCH IMPLANT TRAN CABLE REPL
L8619 0 HCPCS / CPT® COCH IMP EXT PROC/CONTR RPLC
L8621 0 HCPCS / CPT® REPL ZINC AIR BATTERY
L8622 0 HCPCS / CPT® REPL ALKALINE BATTERY
L8623 0 HCPCS / CPT® LITH ION BATT CID,NON-EARLVL
L8624 0 HCPCS / CPT® LITH ION BATT CID, EAR LEVEL
L8627 0 HCPCS / CPT® CID EXT SPEECH PROCESS REPL
L8628 0 HCPCS / CPT® CID EXT CONTROLLER REPL
L8629 0 HCPCS / CPT® CID TRANSMIT COIL AND CABLE
L8630 0 HCPCS / CPT® METACARPOPHALANGEAL IMPLANT
L8631 0 HCPCS / CPT® MCP JOINT REPL 2 PC OR MORE
L8641 0 HCPCS / CPT® METATARSAL JOINT IMPLANT
L8642 0 HCPCS / CPT® HALLUX IMPLANT
L8658 0 HCPCS / CPT® INTERPHALANGEAL JOINT SPACER
L8659 0 HCPCS / CPT® INTERPHALANGEAL JOINT REPL
L8670 0 HCPCS / CPT® VASCULAR GRAFT, SYNTHETIC
L8679 0 HCPCS / CPT® IMP NEUROSTI PLS GN ANY TYPE
L8680 0 HCPCS / CPT® IMPLT NEUROSTIM ELCTR EACH