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