L0112 |
Cranial cervical orthosis |
L0113 |
Cranial cervical torticollis |
L0120 |
Cerv flex n/adj foam pre ots |
L0130 |
Flex thermoplastic collar mo |
L0140 |
Cervical semi-rigid adjustab |
L0150 |
Cerv semi-rig adj molded chn |
L0160 |
Cerv sr wire occ/man pre ots |
L0170 |
Cervical collar molded to pt |
L0172 |
Cerv col sr foam 2pc pre ots |
L0174 |
Cerv sr 2pc thor ext pre ots |
L0180 |
Cer post col occ/man sup adj |
L0190 |
Cerv collar supp adj cerv ba |
L0200 |
Cerv col supp adj bar & thor |
L0220 |
Thor rib belt custom fabrica |
L0450 |
Tlso flex trunk/thor pre ots |
L0452 |
Tlso flex custom fab thoraci |
L0454 |
Tlso trnk sj-t9 pre cst |
L0455 |
Tlso flex trnk sj-t9 pre ots |
L0456 |
Tlso flex trnk sj-ss pre cst |
L0457 |
Tlso flex trnk sj-ss pre ots |
L0458 |
Tlso 2mod symphis-xipho pre |
L0460 |
Tlso 2 shl symphys-stern cst |
L0462 |
Tlso 3mod sacro-scap pre |
L0464 |
Tlso 4mod sacro-scap pre |
L0466 |
Tlso r fram soft ant pre cst |
L0467 |
Tlso r fram soft pre ots |
L0468 |
Tlso rig fram pelvic pre cst |
L0469 |
Tlso rig fram pelvic pre ots |
L0470 |
Tlso rigid frame pre subclav |
L0472 |
Tlso rigid frame hyperex pre |
L0480 |
Tlso rigid plastic custom fa |
L0482 |
Tlso rigid lined custom fab |
L0484 |
Tlso rigid plastic cust fab |
L0486 |
Tlso rigidlined cust fab two |
L0488 |
Tlso rigid lined pre one pie |
L0490 |
Tlso rigid plastic pre one |
L0491 |
Tlso 2 piece rigid shell |
L0492 |
Tlso 3 piece rigid shell |
L0621 |
Sio flex pelvic/sacr pre ots |
L0622 |
Sio flex pelvisacral custom |
L0623 |
Sio rig pnl pelv/sac pre ots |
L0624 |
Sio panel custom |
L0625 |
Lo flex l1-below l5 pre ots |
L0626 |
Lo sag rig pnl stays pre cst |
L0627 |
Lo sag ri an/pos pnl pre cst |
L0628 |
Lso flex no ri stays pre ots |
L0629 |
Lso flex w/rigid stays cust |
L0630 |
Lso r post pnl sj-t9 pre cst |
L0631 |
Lso sag r an/pos pnl pre cst |
L0632 |
Lso sag rigid frame cust |
L0633 |
Lso sc r pos/lat pnl pre cst |
L0634 |
Lso flexion control custom |
L0635 |
Lso sagit rigid panel prefab |
L0636 |
Lso sagittal rigid panel cus |
L0637 |
Lso sc r ant/pos pnl pre cst |
L0638 |
Lso sag-coronal panel custom |
L0639 |
Lso s/c shell/panel prefab |
L0640 |
Lso s/c shell/panel custom |
L0641 |
Lo rig pos pnl l1-l5 pre ots |
L0642 |
Lo sag ri an/pos pnl pre ots |
L0643 |
Lso sag ctr rigi pos pre ots |
L0648 |
Lso sag r an/pos pnl pre ots |
L0649 |
Lso sc r pos/lat pnl pre ots |
L0650 |
Lso sc r ant/pos pnl pre ots |
L0651 |
Lso sag-co shell pnl pre ots |
L0700 |
Ctlso a-p-l control molded |
L0710 |
Ctlso a-p-l control w/ inter |
L0810 |
Halo cervical into jckt vest |
L0820 |
Halo cervical into body jack |
L0830 |
Halo cerv into milwaukee typ |
L0859 |
Mri compatible system |
L0861 |
Halo repl liner/interface |
L0970 |
Tlso corset front |
L0972 |
Lso corset front |
L0974 |
Tlso full corset |
L0976 |
Lso full corset |
L0978 |
Axillary crutch extension |
L0980 |
Peroneal straps pair pre ots |
L0982 |
Stocking sup grips 4 pre ots |
L0984 |
Protect body sock ea pre ots |
L0999 |
Add to spinal orthosis nos |
L1000 |
Ctlso milwauke initial model |
L1001 |
Ctlso infant immobilizer |
L1005 |
Tension based scoliosis orth |
L1010 |
Ctlso axilla sling |
L1020 |
Kyphosis pad |
L1025 |
Kyphosis pad floating |
L1030 |
Lumbar bolster pad |
L1040 |
Lumbar or lumbar rib pad |
L1050 |
Sternal pad |
L1060 |
Thoracic pad |
L1070 |
Trapezius sling |
L1080 |
Outrigger |
L1085 |
Outrigger bil w/ vert extens |
L1090 |
Lumbar sling |
L1100 |
Ring flange plastic/leather |
L1110 |
Ring flange plas/leather mol |
L1120 |
Covers for upright each |
L1200 |
Furnsh initial orthosis only |
L1210 |
Lateral thoracic extension |
L1220 |
Anterior thoracic extension |
L1230 |
Milwaukee type superstructur |
L1240 |
Lumbar derotation pad |
L1250 |
Anterior asis pad |
L1260 |
Anterior thoracic derotation |
L1270 |
Abdominal pad |
L1280 |
Rib gusset (elastic) each |
L1290 |
Lateral trochanteric pad |
L1300 |
Body jacket mold to patient |
L1310 |
Post-operative body jacket |
L1499 |
Spinal orthosis nos |
L1600 |
Ho flex frejka w/cov pre cst |
L1610 |
Ho frejka cov only pre cst |
L1620 |
Ho flex pavlik harns pre cst |
L1630 |
Abduct control hip semi-flex |
L1640 |
Pelv band/spread bar thigh c |
L1650 |
Ho abduction hip adjustable |
L1652 |
Ho bi thighcuffs w sprdr bar |
L1660 |
Ho abduction static plastic |
L1680 |
Pelvic & hip control thigh c |
L1685 |
Post-op hip abduct custom fa |
L1686 |
Ho post-op hip abduction |
L1690 |
Combination bilateral ho |
L1700 |
Leg perthes orth toronto typ |
L1710 |
Legg perthes orth newington |
L1720 |
Legg perthes orthosis trilat |
L1730 |
Legg perthes orth scottish r |
L1755 |
Legg perthes patten bottom t |
L1810 |
Ko elastic with joints |
L1812 |
Ko elastic w/joints pre ots |
L1820 |
Ko elas w/ condyle pads & jo |
L1830 |
Ko immob canvas long pre ots |
L1831 |
Knee orth pos locking joint |
L1832 |
Ko adj jnt pos r sup pre cst |
L1833 |
Ko adj jnt pos r sup pre ots |
L1834 |
Ko w/0 joint rigid molded to |
L1836 |
Ko rigid w/o joints pre ots |
L1840 |
Ko derot ant cruciate custom |
L1843 |
Ko single upright pre cst |
L1844 |
Ko w/adj jt rot cntrl molded |
L1845 |
Ko double upright pre cst |
L1846 |
Ko w adj flex/ext rotat mold |
L1847 |
Ko dbl upright w/air pre cst |
L1848 |
Ko dbl upright w/air pre ots |
L1850 |
Ko swedish type pre ots |
L1851 |
Ko single upright prefab ots |
L1852 |
Ko double upright prefab ots |
L1860 |
Ko supracondylar socket mold |
L1900 |
Afo sprng wir drsflx calf bd |
L1902 |
Afo ankle gauntlet pre ots |
L1904 |
Afo molded ankle gauntlet |
L1906 |
Afo multilig ank sup pre ots |
L1907 |
Afo supramalleolar custom |
L1910 |
Afo sing bar clasp attach sh |
L1920 |
Afo sing upright w/ adjust s |
L1930 |
Afo plastic |
L1932 |
Afo rig ant tib prefab tcf/= |
L1940 |
Afo molded to patient plasti |
L1945 |
Afo molded plas rig ant tib |
L1950 |
Afo spiral molded to pt plas |
L1951 |
Afo spiral prefabricated |
L1960 |
Afo pos solid ank plastic mo |
L1970 |
Afo plastic molded w/ankle j |
L1971 |
Afo w/ankle joint, prefab |
L1980 |
Afo sing solid stirrup calf |
L1990 |
Afo doub solid stirrup calf |
L2000 |
Kafo sing fre stirr thi/calf |
L2005 |
Kafo sng/dbl mechanical act |
L2006 |
Kaf sng/dbl swg/stn mcpr cus |
L2010 |
Kafo sng solid stirrup w/o j |
L2020 |
Kafo dbl solid stirrup band/ |
L2030 |
Kafo dbl solid stirrup w/o j |
L2034 |
Kafo pla sin up w/wo k/a cus |
L2035 |
Kafo plastic pediatric size |
L2036 |
Kafo plas doub free knee mol |
L2037 |
Kafo plas sing free knee mol |
L2038 |
Kafo w/o joint multi-axis an |
L2040 |
Hkafo torsion bil rot straps |
L2050 |
Hkafo torsion cable hip pelv |
L2060 |
Hkafo torsion ball bearing j |
L2070 |
Hkafo torsion unilat rot str |
L2080 |
Hkafo unilat torsion cable |
L2090 |
Hkafo unilat torsion ball br |
L2106 |
Afo tib fx cast plaster mold |
L2108 |
Afo tib fx cast molded to pt |
L2112 |
Afo tibial fracture soft |
L2114 |
Afo tib fx semi-rigid |
L2116 |
Afo tibial fracture rigid |
L2126 |
Kafo fem fx cast thermoplas |
L2128 |
Kafo fem fx cast molded to p |
L2132 |
Kafo femoral fx cast soft |
L2134 |
Kafo fem fx cast semi-rigid |
L2136 |
Kafo femoral fx cast rigid |
L2180 |
Plas shoe insert w ank joint |
L2182 |
Drop lock knee |
L2184 |
Limited motion knee joint |
L2186 |
Adj motion knee jnt lerman t |
L2188 |
Quadrilateral brim |
L2190 |
Waist belt |
L2192 |
Pelvic band & belt thigh fla |
L2200 |
Limited ankle motion ea jnt |
L2210 |
Dorsiflexion assist each joi |
L2220 |
Dorsi & plantar flex ass/res |
L2230 |
Split flat caliper stirr & p |
L2232 |
Rocker bottom, contact afo |
L2240 |
Round caliper and plate atta |
L2250 |
Foot plate molded stirrup at |
L2260 |
Reinforced solid stirrup |
L2265 |
Long tongue stirrup |
L2270 |
Varus/valgus strap padded/li |
L2275 |
Plastic mod low ext pad/line |
L2280 |
Molded inner boot |
L2300 |
Abduction bar jointed adjust |
L2310 |
Abduction bar-straight |
L2320 |
Non-molded lacer |
L2330 |
Lacer molded to patient mode |
L2335 |
Anterior swing band |
L2340 |
Pre-tibial shell molded to p |
L2350 |
Prosthetic type socket molde |
L2360 |
Extended steel shank |
L2370 |
Patten bottom |
L2375 |
Torsion ank & half solid sti |
L2380 |
Torsion straight knee joint |
L2385 |
Straight knee joint heavy du |
L2387 |
Add le poly knee custom kafo |
L2390 |
Offset knee joint each |
L2395 |
Offset knee joint heavy duty |
L2397 |
Suspension sleeve lower ext |
L2405 |
Knee joint drop lock ea jnt |
L2415 |
Knee joint cam lock each joi |
L2425 |
Knee disc/dial lock/adj flex |
L2430 |
Knee jnt ratchet lock ea jnt |
L2492 |
Knee lift loop drop lock rin |
L2500 |
Thi/glut/ischia wgt bearing |
L2510 |
Th/wght bear quad-lat brim m |
L2520 |
Th/wght bear quad-lat brim c |
L2525 |
Th/wght bear nar m-l brim mo |
L2526 |
Th/wght bear nar m-l brim cu |
L2530 |
Thigh/wght bear lacer non-mo |
L2540 |
Thigh/wght bear lacer molded |
L2550 |
Thigh/wght bear high roll cu |
L2570 |
Hip clevis type 2 posit jnt |
L2580 |
Pelvic control pelvic sling |
L2600 |
Hip clevis/thrust bearing fr |
L2610 |
Hip clevis/thrust bearing lo |
L2620 |
Pelvic control hip heavy dut |
L2622 |
Hip joint adjustable flexion |
L2624 |
Hip adj flex ext abduct cont |
L2627 |
Plastic mold recipro hip & c |
L2628 |
Metal frame recipro hip & ca |
L2630 |
Pelvic control band & belt u |
L2640 |
Pelvic control band & belt b |
L2650 |
Pelv & thor control gluteal |
L2660 |
Thoracic control thoracic ba |
L2670 |
Thorac cont paraspinal uprig |
L2680 |
Thorac cont lat support upri |
L2750 |
Plating chrome/nickel pr bar |
L2755 |
Carbon graphite lamination |
L2760 |
Extension per extension per |
L2768 |
Ortho sidebar disconnect |
L2780 |
Non-corrosive finish |
L2785 |
Drop lock retainer each |
L2795 |
Knee control full kneecap |
L2800 |
Knee cap medial or lateral p |
L2810 |
Knee control condylar pad |
L2820 |
Soft interface below knee se |
L2830 |
Soft interface above knee se |
L2840 |
Tibial length sock fx or equ |
L2850 |
Femoral lgth sock fx or equa |
L2861 |
Torsion mechanism knee/ankle |
L2999 |
Lower extremity orthosis nos |
L3000 |
Ft insert ucb berkeley shell |
L3001 |
Foot insert remov molded spe |
L3002 |
Foot insert plastazote or eq |
L3003 |
Foot insert silicone gel eac |
L3010 |
Foot longitudinal arch suppo |
L3020 |
Foot longitud/metatarsal sup |
L3030 |
Foot arch support remov prem |
L3031 |
Foot lamin/prepreg composite |
L3040 |
Ft arch suprt premold longit |
L3050 |
Foot arch supp premold metat |
L3060 |
Foot arch supp longitud/meta |
L3070 |
Arch suprt att to sho longit |
L3080 |
Arch supp att to shoe metata |
L3090 |
Arch supp att to shoe long/m |
L3100 |
Hallus-valgus nt dyn pre ots |
L3140 |
Abduction rotation bar shoe |
L3150 |
Abduct rotation bar w/o shoe |
L3160 |
Shoe styled positioning dev |
L3170 |
Foot plas heel stabi pre ots |
L3201 |
Oxford w supinat/pronat inf |
L3202 |
Oxford w/ supinat/pronator c |
L3203 |
Oxford w/ supinator/pronator |
L3204 |
Hightop w/ supp/pronator inf |
L3206 |
Hightop w/ supp/pronator chi |
L3207 |
Hightop w/ supp/pronator jun |
L3208 |
Surgical boot each infant |
L3209 |
Surgical boot each child |
L3211 |
Surgical boot each junior |
L3212 |
Benesch boot pair infant |
L3213 |
Benesch boot pair child |
L3214 |
Benesch boot pair junior |
L3215 |
Orthopedic ftwear ladies oxf |
L3216 |
Orthoped ladies shoes dpth i |
L3217 |
Ladies shoes hightop depth i |
L3219 |
Orthopedic mens shoes oxford |
L3221 |
Orthopedic mens shoes dpth i |
L3222 |
Mens shoes hightop depth inl |
L3224 |
Woman's shoe oxford brace |
L3225 |
Man's shoe oxford brace |
L3230 |
Custom shoes depth inlay |
L3250 |
Custom mold shoe remov prost |
L3251 |
Shoe molded to pt silicone s |
L3252 |
Shoe molded plastazote cust |
L3253 |
Shoe molded plastazote cust |
L3254 |
Orth foot non-stndard size/w |
L3255 |
Orth foot non-standard size/ |
L3257 |
Orth foot add charge split s |
L3260 |
Ambulatory surgical boot eac |
L3265 |
Plastazote sandal each |
L3300 |
Sho lift taper to metatarsal |
L3310 |
Shoe lift elev heel/sole neo |
L3320 |
Shoe lift elev heel/sole cor |
L3330 |
Lifts elevation metal extens |
L3332 |
Shoe lifts tapered to one-ha |
L3334 |
Shoe lifts elevation heel /i |
L3340 |
Shoe wedge sach |
L3350 |
Shoe heel wedge |
L3360 |
Shoe sole wedge outside sole |
L3370 |
Shoe sole wedge between sole |
L3380 |
Shoe clubfoot wedge |
L3390 |
Shoe outflare wedge |
L3400 |
Shoe metatarsal bar wedge ro |
L3410 |
Shoe metatarsal bar between |
L3420 |
Full sole/heel wedge btween |
L3430 |
Sho heel count plast reinfor |
L3440 |
Heel leather reinforced |
L3450 |
Shoe heel sach cushion type |
L3455 |
Shoe heel new leather standa |
L3460 |
Shoe heel new rubber standar |
L3465 |
Shoe heel thomas with wedge |
L3470 |
Shoe heel thomas extend to b |
L3480 |
Shoe heel pad & depress for |
L3485 |
Shoe heel pad removable for |
L3500 |
Ortho shoe add leather insol |
L3510 |
Orthopedic shoe add rub insl |
L3520 |
O shoe add felt w leath insl |
L3530 |
Ortho shoe add half sole |
L3540 |
Ortho shoe add full sole |
L3550 |
O shoe add standard toe tap |
L3560 |
O shoe add horseshoe toe tap |
L3570 |
O shoe add instep extension |
L3580 |
O shoe add instep velcro clo |
L3590 |
O shoe convert to sof counte |
L3595 |
Ortho shoe add march bar |
L3600 |
Trans shoe calip plate exist |
L3610 |
Trans shoe caliper plate new |
L3620 |
Trans shoe solid stirrup exi |
L3630 |
Trans shoe solid stirrup new |
L3640 |
Shoe dennis browne splint bo |
L3649 |
Orthopedic shoe modifica nos |
L3650 |
So 8 abd restraint pre ots |
L3660 |
So 8 ab rstr can/web pre ots |
L3670 |
So acro/clav can web pre ots |
L3671 |
So cap design w/o jnts cf |
L3674 |
So airplane w/wo joint cf |
L3675 |
So vest canvas/web pre ots |
L3677 |
So hard plas stabili pre cst |
L3678 |
So hard plas stabili pre ots |
L3702 |
Eo w/o joints cf |
L3710 |
Eo elas w/metal jnts pre ots |
L3720 |
Forearm/arm cuffs free motio |
L3730 |
Forearm/arm cuffs ext/flex a |
L3740 |
Cuffs adj lock w/ active con |
L3760 |
Eo adj jt prefab custom fit |
L3761 |
Eo, adj lock joint prefab ot |
L3762 |
Eo rigid w/o joints pre ots |
L3763 |
Ewho rigid w/o jnts cf |
L3764 |
Ewho w/joint(s) cf |
L3765 |
Ewhfo rigid w/o jnts cf |
L3766 |
Ewhfo w/joint(s) cf |
L3806 |
Whfo w/joint(s) custom fab |
L3807 |
Whfo w/o joints pre cst |
L3808 |
Whfo, rigid w/o joints |
L3809 |
Whfo w/o joints pre ots |
L3891 |
Torsion mechanism wrist/elbo |
L3900 |
Hinge extension/flex wrist/f |
L3901 |
Hinge ext/flex wrist finger |
L3904 |
Whfo electric custom fitted |
L3905 |
Who w/nontorsion jnt(s) cf |
L3906 |
Who w/o joints cf |
L3908 |
Who cock-up nonmolde pre ots |
L3912 |
Hfo flexion glove pre ots |
L3913 |
Hfo w/o joints cf |
L3915 |
Who nontorsion jnts pre cst |
L3916 |
Who nontorsion jnts pre ots |
L3917 |
Metacarp fx orthosis pre cst |
L3918 |
Metacarp fx orthosis pre ots |
L3919 |
Ho w/o joints cf |
L3921 |
Hfo w/joint(s) cf |
L3923 |
Hfo without joints pre cst |
L3924 |
Hfo without joints pre ots |
L3925 |
Fo pip dip jnt/sprng pre ots |
L3927 |
Fo pip dip no jt spr pre ots |
L3929 |
Hfo nontorsion jnts pre cst |
L3930 |
Hfo nontorsion jnts pre ots |
L3931 |
Whfo nontorsion joint prefab |
L3933 |
Fo w/o joints cf |
L3935 |
Fo nontorsion joint cf |
L3956 |
Add joint upper ext orthosis |
L3960 |
Sewho airplan desig abdu pos |
L3961 |
Sewho cap design w/o jnts cf |
L3962 |
Sewho erbs palsey design abd |
L3967 |
Sewho airplane w/o jnts cf |
L3971 |
Sewho cap design w/jnt(s) cf |
L3973 |
Sewho airplane w/jnt(s) cf |
L3975 |
Sewhfo cap design w/o jnt cf |
L3976 |
Sewhfo airplane w/o jnts cf |
L3977 |
Sewhfo cap desgn w/jnt(s) cf |
L3978 |
Sewhfo airplane w/jnt(s) cf |
L3980 |
Up ext fx orthos humeral nos |
L3981 |
Ue fx orth shoul cap forearm |
L3982 |
Upper ext fx orthosis rad/ul |
L3984 |
Upper ext fx orthosis wrist |
L3995 |
Sock fracture or equal each |
L3999 |
Upper limb orthosis nos |
L4000 |
Repl girdle milwaukee orth |
L4002 |
Replace strap, any orthosis |
L4010 |
Replace trilateral socket br |
L4020 |
Replace quadlat socket brim |
L4030 |
Replace socket brim cust fit |
L4040 |
Replace molded thigh lacer |
L4045 |
Replace non-molded thigh lac |
L4050 |
Replace molded calf lacer |
L4055 |
Replace non-molded calf lace |
L4060 |
Replace high roll cuff |
L4070 |
Replace prox & dist upright |
L4080 |
Repl met band kafo-afo prox |
L4090 |
Repl met band kafo-afo calf/ |
L4100 |
Repl leath cuff kafo prox th |
L4110 |
Repl leath cuff kafo-afo cal |
L4130 |
Replace pretibial shell |
L4205 |
Ortho dvc repair per 15 min |
L4210 |
Orth dev repair/repl minor p |
L4350 |
Ankle control ortho pre ots |
L4360 |
Pneumat walking boot pre cst |
L4361 |
Pneuma/vac walk boot pre ots |
L4370 |
Pneum full leg splnt pre ots |
L4386 |
Non-pneum walk boot pre cst |
L4387 |
Non-pneum walk boot pre ots |
L4392 |
Replace afo soft interface |
L4394 |
Replace foot drop spint |
L4396 |
Static or dynami afo pre cst |
L4397 |
Static or dynami afo pre ots |
L4398 |
Foot drop splint pre ots |
L4631 |
Afo, walk boot type, cus fab |
L5000 |
Sho insert w arch toe filler |
L5010 |
Mold socket ank hgt w/ toe f |
L5020 |
Tibial tubercle hgt w/ toe f |
L5050 |
Ank symes mold sckt sach ft |
L5060 |
Symes met fr leath socket ar |
L5100 |
Molded socket shin sach foot |
L5105 |
Plast socket jts/thgh lacer |
L5150 |
Mold sckt ext knee shin sach |
L5160 |
Mold socket bent knee shin s |
L5200 |
Kne sing axis fric shin sach |
L5210 |
No knee/ankle joints w/ ft b |
L5220 |
No knee joint with artic ali |
L5230 |
Fem focal defic constant fri |
L5250 |
Hip canad sing axi cons fric |
L5270 |
Tilt table locking hip sing |
L5280 |
Hemipelvect canad sing axis |
L5301 |
Bk mold socket sach ft endo |
L5312 |
Knee disart, sach ft, endo |
L5321 |
Ak open end sach |
L5331 |
Hip disart canadian sach ft |
L5341 |
Hemipelvectomy canadian sach |
L5400 |
Postop dress & 1 cast chg bk |
L5410 |
Postop dsg bk ea add cast ch |
L5420 |
Postop dsg & 1 cast chg ak/d |
L5430 |
Postop dsg ak ea add cast ch |
L5450 |
Postop app non-wgt bear dsg |
L5460 |
Postop app non-wgt bear dsg |
L5500 |
Init bk ptb plaster direct |
L5505 |
Init ak ischal plstr direct |
L5510 |
Prep bk ptb plaster molded |
L5520 |
Perp bk ptb thermopls direct |
L5530 |
Prep bk ptb thermopls molded |
L5535 |
Prep bk ptb open end socket |
L5540 |
Prep bk ptb laminated socket |
L5560 |
Prep ak ischial plast molded |
L5570 |
Prep ak ischial direct form |
L5580 |
Prep ak ischial thermo mold |
L5585 |
Prep ak ischial open end |
L5590 |
Prep ak ischial laminated |
L5595 |
Hip disartic sach thermopls |
L5600 |
Hip disart sach laminat mold |
L5610 |
Above knee hydracadence |
L5611 |
Ak 4 bar link w/fric swing |
L5613 |
Ak 4 bar ling w/hydraul swig |
L5614 |
4-bar link above knee w/swng |
L5616 |
Ak univ multiplex sys frict |
L5617 |
Ak/bk self-aligning unit ea |
L5618 |
Test socket symes |
L5620 |
Test socket below knee |
L5622 |
Test socket knee disarticula |
L5624 |
Test socket above knee |
L5626 |
Test socket hip disarticulat |
L5628 |
Test socket hemipelvectomy |
L5629 |
Below knee acrylic socket |
L5630 |
Syme typ expandabl wall sckt |
L5631 |
Ak/knee disartic acrylic soc |
L5632 |
Symes type ptb brim design s |
L5634 |
Symes type poster opening so |
L5636 |
Symes type medial opening so |
L5637 |
Below knee total contact |
L5638 |
Below knee leather socket |
L5639 |
Below knee wood socket |
L5640 |
Knee disarticulat leather so |
L5642 |
Above knee leather socket |
L5643 |
Hip flex inner socket ext fr |
L5644 |
Above knee wood socket |
L5645 |
Bk flex inner socket ext fra |
L5646 |
Below knee cushion socket |
L5647 |
Below knee suction socket |
L5648 |
Above knee cushion socket |
L5649 |
Isch containmt/narrow m-l so |
L5650 |
Tot contact ak/knee disart s |
L5651 |
Ak flex inner socket ext fra |
L5652 |
Suction susp ak/knee disart |
L5653 |
Knee disart expand wall sock |
L5654 |
Socket insert symes |
L5655 |
Socket insert below knee |
L5656 |
Socket insert knee articulat |
L5658 |
Socket insert above knee |
L5661 |
Multi-durometer symes |
L5665 |
Multi-durometer below knee |
L5666 |
Below knee cuff suspension |
L5668 |
Bk molded distal cushion |
L5670 |
Bk molded supracondylar susp |
L5671 |
Bk/ak locking mechanism |
L5672 |
Bk removable medial brim sus |
L5673 |
Socket insert w lock mech |
L5676 |
Bk knee joints single axis p |
L5677 |
Bk knee joints polycentric p |
L5678 |
Bk joint covers pair |
L5679 |
Socket insert w/o lock mech |
L5680 |
Bk thigh lacer non-molded |
L5681 |
Intl custm cong/latyp insert |
L5682 |
Bk thigh lacer glut/ischia m |
L5683 |
Initial custom socket insert |
L5684 |
Bk fork strap |
L5685 |
Below knee sus/seal sleeve |
L5686 |
Bk back check |
L5688 |
Bk waist belt webbing |
L5690 |
Bk waist belt padded and lin |
L5692 |
Ak pelvic control belt light |
L5694 |
Ak pelvic control belt pad/l |
L5695 |
Ak sleeve susp neoprene/equa |
L5696 |
Ak/knee disartic pelvic join |
L5697 |
Ak/knee disartic pelvic band |
L5698 |
Ak/knee disartic silesian ba |
L5699 |
Shoulder harness |
L5700 |
Replace socket below knee |
L5701 |
Replace socket above knee |
L5702 |
Replace socket hip |
L5703 |
Symes ankle w/o (sach) foot |
L5704 |
Custom shape cover bk |
L5705 |
Custom shape cover ak |
L5706 |
Custom shape cvr knee disart |
L5707 |
Custom shape cvr hip disart |
L5710 |
Kne-shin exo sng axi mnl loc |
L5711 |
Knee-shin exo mnl lock ultra |
L5712 |
Knee-shin exo frict swg & st |
L5714 |
Knee-shin exo variable frict |
L5716 |
Knee-shin exo mech stance ph |
L5718 |
Knee-shin exo frct swg & sta |
L5722 |
Knee-shin pneum swg frct exo |
L5724 |
Knee-shin exo fluid swing ph |
L5726 |
Knee-shin ext jnts fld swg e |
L5728 |
Knee-shin fluid swg & stance |
L5780 |
Knee-shin pneum/hydra pneum |
L5781 |
Lower limb pros vacuum pump |
L5782 |
Hd low limb pros vacuum pump |
L5785 |
Exoskeletal bk ultralt mater |
L5790 |
Exoskeletal ak ultra-light m |
L5795 |
Exoskel hip ultra-light mate |
L5810 |
Endoskel knee-shin mnl lock |
L5811 |
Endo knee-shin mnl lck ultra |
L5812 |
Endo knee-shin frct swg & st |
L5814 |
Endo knee-shin hydral swg ph |
L5816 |
Endo knee-shin polyc mch sta |
L5818 |
Endo knee-shin frct swg & st |
L5822 |
Endo knee-shin pneum swg frc |
L5824 |
Endo knee-shin fluid swing p |
L5826 |
Miniature knee joint |
L5828 |
Endo knee-shin fluid swg/sta |
L5830 |
Endo knee-shin pneum/swg pha |
L5840 |
Multi-axial knee/shin system |
L5845 |
Knee-shin sys stance flexion |
L5848 |
Knee-shin sys hydraul stance |
L5850 |
Endo ak/hip knee extens assi |
L5855 |
Mech hip extension assist |
L5856 |
Elec knee-shin swing/stance |
L5857 |
Elec knee-shin swing only |
L5858 |
Stance phase only |
L5859 |
Knee-shin pro flex/ext cont |
L5910 |
Endo below knee alignable sy |
L5920 |
Endo ak/hip alignable system |
L5925 |
Above knee manual lock |
L5930 |
High activity knee frame |
L5940 |
Endo bk ultra-light material |
L5950 |
Endo ak ultra-light material |
L5960 |
Endo hip ultra-light materia |
L5961 |
Endo poly hip, pneu/hyd/rot |
L5962 |
Below knee flex cover system |
L5964 |
Above knee flex cover system |
L5966 |
Hip flexible cover system |
L5968 |
Multiaxial ankle w dorsiflex |
L5969 |
Ak/ft power asst incl motors |
L5970 |
Foot external keel sach foot |
L5971 |
Sach foot, replacement |
L5972 |
Flexible keel foot |
L5973 |
Ank-foot sys dors-plant flex |
L5974 |
Foot single axis ankle/foot |
L5975 |
Combo ankle/foot prosthesis |
L5976 |
Energy storing foot |
L5978 |
Ft prosth multiaxial ankl/ft |
L5979 |
Multi-axial ankle/ft prosth |
L5980 |
Flex foot system |
L5981 |
Flex-walk sys low ext prosth |
L5982 |
Exoskeletal axial rotation u |
L5984 |
Endoskeletal axial rotation |
L5985 |
Lwr ext dynamic prosth pylon |
L5986 |
Multi-axial rotation unit |
L5987 |
Shank ft w vert load pylon |
L5988 |
Vertical shock reducing pylo |
L5990 |
User adjustable heel height |
L5999 |
Lowr extremity prosthes nos |
L6000 |
Part hand thumb rem |
L6010 |
Part hand little/ring |
L6020 |
Part hand no fingers |
L6026 |
Part hand myo exclu term dev |
L6050 |
Wrst mld sck flx hng tri pad |
L6055 |
Wrst mold sock w/exp interfa |
L6100 |
Elb mold sock flex hinge pad |
L6110 |
Elbow mold sock suspension t |
L6120 |
Elbow mold doub splt soc ste |
L6130 |
Elbow stump activated lock h |
L6200 |
Elbow mold outsid lock hinge |
L6205 |
Elbow molded w/ expand inter |
L6250 |
Elbow inter loc elbow forarm |
L6300 |
Shlder disart int lock elbow |
L6310 |
Shoulder passive restor comp |
L6320 |
Shoulder passive restor cap |
L6350 |
Thoracic intern lock elbow |
L6360 |
Thoracic passive restor comp |
L6370 |
Thoracic passive restor cap |
L6380 |
Postop dsg cast chg wrst/elb |
L6382 |
Postop dsg cast chg elb dis/ |
L6384 |
Postop dsg cast chg shlder/t |
L6386 |
Postop ea cast chg & realign |
L6388 |
Postop applicat rigid dsg on |
L6400 |
Below elbow prosth tiss shap |
L6450 |
Elb disart prosth tiss shap |
L6500 |
Above elbow prosth tiss shap |
L6550 |
Shldr disar prosth tiss shap |
L6570 |
Scap thorac prosth tiss shap |
L6580 |
Wrist/elbow bowden cable mol |
L6582 |
Wrist/elbow bowden cbl dir f |
L6584 |
Elbow fair lead cable molded |
L6586 |
Elbow fair lead cable dir fo |
L6588 |
Shdr fair lead cable molded |
L6590 |
Shdr fair lead cable direct |
L6600 |
Polycentric hinge pair |
L6605 |
Single pivot hinge pair |
L6610 |
Flexible metal hinge pair |
L6611 |
Additional switch, ext power |
L6615 |
Disconnect locking wrist uni |
L6616 |
Disconnect insert locking wr |
L6620 |
Flexion/extension wrist unit |
L6621 |
Flex/ext wrist w/wo friction |
L6623 |
Spring-ass rot wrst w/ latch |
L6624 |
Flex/ext/rotation wrist unit |
L6625 |
Rotation wrst w/ cable lock |
L6628 |
Quick disconn hook adapter o |
L6629 |
Lamination collar w/ couplin |
L6630 |
Stainless steel any wrist |
L6632 |
Latex suspension sleeve each |
L6635 |
Lift assist for elbow |
L6637 |
Nudge control elbow lock |
L6638 |
Elec lock on manual pw elbow |
L6640 |
Shoulder abduction joint pai |
L6641 |
Excursion amplifier pulley t |
L6642 |
Excursion amplifier lever ty |
L6645 |
Shoulder flexion-abduction j |
L6646 |
Multipo locking shoulder jnt |
L6647 |
Shoulder lock actuator |
L6648 |
Ext pwrd shlder lock/unlock |
L6650 |
Shoulder universal joint |
L6655 |
Standard control cable extra |
L6660 |
Heavy duty control cable |
L6665 |
Teflon or equal cable lining |
L6670 |
Hook to hand cable adapter |
L6672 |
Harness chest/shlder saddle |
L6675 |
Harness figure of 8 sing con |
L6676 |
Harness figure of 8 dual con |
L6677 |
Ue triple control harness |
L6680 |
Test sock wrist disart/bel e |
L6682 |
Test sock elbw disart/above |
L6684 |
Test socket shldr disart/tho |
L6686 |
Suction socket |
L6687 |
Frame typ socket bel elbow/w |
L6688 |
Frame typ sock above elb/dis |
L6689 |
Frame typ socket shoulder di |
L6690 |
Frame typ sock interscap-tho |
L6691 |
Removable insert each |
L6692 |
Silicone gel insert or equal |
L6693 |
Lockingelbow forearm cntrbal |
L6694 |
Elbow socket ins use w/lock |
L6695 |
Elbow socket ins use w/o lck |
L6696 |
Cus elbo skt in for con/atyp |
L6697 |
Cus elbo skt in not con/atyp |
L6698 |
Below/above elbow lock mech |
L6703 |
Term dev, passive hand mitt |
L6704 |
Term dev, sport/rec/work att |
L6706 |
Term dev mech hook vol open |
L6707 |
Term dev mech hook vol close |
L6708 |
Term dev mech hand vol open |
L6709 |
Term dev mech hand vol close |
L6711 |
Ped term dev, hook, vol open |
L6712 |
Ped term dev, hook, vol clos |
L6713 |
Ped term dev, hand, vol open |
L6714 |
Ped term dev, hand, vol clos |
L6715 |
Term device, multi art digit |
L6721 |
Hook/hand, hvy dty, vol open |
L6722 |
Hook/hand, hvy dty, vol clos |
L6805 |
Term dev modifier wrist unit |
L6810 |
Term dev precision pinch dev |
L6880 |
Elec hand ind art digits |
L6881 |
Term dev auto grasp feature |
L6882 |
Microprocessor control uplmb |
L6883 |
Replc sockt below e/w disa |
L6884 |
Replc sockt above elbow disa |
L6885 |
Replc sockt shldr dis/interc |
L6890 |
Prefab glove for term device |
L6895 |
Custom glove for term device |
L6900 |
Hand restorat thumb/1 finger |
L6905 |
Hand restoration multiple fi |
L6910 |
Hand restoration no fingers |
L6915 |
Hand restoration replacmnt g |
L6920 |
Wrist disarticul switch ctrl |
L6925 |
Wrist disart myoelectronic c |
L6930 |
Below elbow switch control |
L6935 |
Below elbow myoelectronic ct |
L6940 |
Elbow disarticulation switch |
L6945 |
Elbow disart myoelectronic c |
L6950 |
Above elbow switch control |
L6955 |
Above elbow myoelectronic ct |
L6960 |
Shldr disartic switch contro |
L6965 |
Shldr disartic myoelectronic |
L6970 |
Interscapular-thor switch ct |
L6975 |
Interscap-thor myoelectronic |
L7007 |
Adult electric hand |
L7008 |
Pediatric electric hand |
L7009 |
Adult electric hook |
L7040 |
Prehensile actuator |
L7045 |
Pediatric electric hook |
L7170 |
Electronic elbow hosmer swit |
L7180 |
Electronic elbow sequential |
L7181 |
Electronic elbo simultaneous |
L7185 |
Electron elbow adolescent sw |
L7186 |
Electron elbow child switch |
L7190 |
Elbow adolescent myoelectron |
L7191 |
Elbow child myoelectronic ct |
L7259 |
Electronic wrist rotator any |
L7360 |
Six volt bat otto bock/eq ea |
L7362 |
Battery chrgr six volt otto |
L7364 |
Twelve volt battery utah/equ |
L7366 |
Battery chrgr 12 volt utah/e |
L7367 |
Replacemnt lithium ionbatter |
L7368 |
Lithium ion battery charger |
L7400 |
Add ue prost be/wd, ultlite |
L7401 |
Add ue prost a/e ultlite mat |
L7402 |
Add ue prost s/d ultlite mat |
L7403 |
Add ue prost b/e acrylic |
L7404 |
Add ue prost a/e acrylic |
L7405 |
Add ue prost s/d acrylic |
L7499 |
Upper extremity prosthes nos |
L7510 |
Prosthetic device repair rep |
L7520 |
Repair prosthesis per 15 min |
L7600 |
Prosthetic donning sleeve |
L7700 |
Pros soc insert gasket/seal |
L7900 |
Male vacuum erection system |
L7902 |
Tension ring, vac erect dev |
L8000 |
Mastectomy bra |
L8001 |
Breast prosthesis bra & form |
L8002 |
Brst prsth bra & bilat form |
L8010 |
Mastectomy sleeve |
L8015 |
Ext breastprosthesis garment |
L8020 |
Mastectomy form |
L8030 |
Breast prosthes w/o adhesive |
L8031 |
Breast prosthesis w adhesive |
L8032 |
Reusable nipple prosthesis |
L8033 |
Nipple prosthesis custom, ea |
L8035 |
Custom breast prosthesis |
L8039 |
Breast prosthesis nos |
L8040 |
Nasal prosthesis |
L8041 |
Midfacial prosthesis |
L8042 |
Orbital prosthesis |
L8043 |
Upper facial prosthesis |
L8044 |
Hemi-facial prosthesis |
L8045 |
Auricular prosthesis |
L8046 |
Partial facial prosthesis |
L8047 |
Nasal septal prosthesis |
L8048 |
Unspec maxillofacial prosth |
L8049 |
Repair maxillofacial prosth |
L8300 |
Truss single w/ standard pad |
L8310 |
Truss double w/ standard pad |
L8320 |
Truss addition to std pad wa |
L8330 |
Truss add to std pad scrotal |
L8400 |
Sheath below knee |
L8410 |
Sheath above knee |
L8415 |
Sheath upper limb |
L8417 |
Pros sheath/sock w gel cushn |
L8420 |
Prosthetic sock multi ply bk |
L8430 |
Prosthetic sock multi ply ak |
L8435 |
Pros sock multi ply upper lm |
L8440 |
Shrinker below knee |
L8460 |
Shrinker above knee |
L8465 |
Shrinker upper limb |
L8470 |
Pros sock single ply bk |
L8480 |
Pros sock single ply ak |
L8485 |
Pros sock single ply upper l |
L8499 |
Unlisted misc prosthetic ser |
L8500 |
Artificial larynx |
L8501 |
Tracheostomy speaking valve |
L8505 |
Artificial larynx, accessory |
L8507 |
Trach-esoph voice pros pt in |
L8509 |
Trach-esoph voice pros md in |
L8510 |
Voice amplifier |
L8511 |
Indwelling trach insert |
L8512 |
Gel cap for trach voice pros |
L8513 |
Trach pros cleaning device |
L8514 |
Repl trach puncture dilator |
L8515 |
Gel cap app device for trach |
L8600 |
Implant breast silicone/eq |
L8603 |
Collagen imp urinary 2.5 ml |
L8604 |
Dextranomer/hyaluronic acid |
L8605 |
Inj bulking agent anal canal |
L8606 |
Synthetic implnt urinary 1ml |
L8607 |
Inj vocal cord bulking agent |
L8608 |
Arg ii ext com/sup/acc misc |
L8609 |
Artificial cornea |
L8610 |
Ocular implant |
L8612 |
Aqueous shunt prosthesis |
L8613 |
Ossicular implant |
L8614 |
Cochlear device |
L8615 |
Coch implant headset replace |
L8616 |
Coch implant microphone repl |
L8617 |
Coch implant trans coil repl |
L8618 |
Coch implant tran cable repl |
L8619 |
Coch imp ext proc/contr rplc |
L8621 |
Repl zinc air battery |
L8622 |
Repl alkaline battery |
L8623 |
Lith ion batt cid,non-earlvl |
L8624 |
Lith ion batt cid, ear level |
L8625 |
Charger coch impl/aoi battry |
L8627 |
Cid ext speech process repl |
L8628 |
Cid ext controller repl |
L8629 |
Cid transmit coil and cable |
L8630 |
Metacarpophalangeal implant |
L8631 |
Mcp joint repl 2 pc or more |
L8641 |
Metatarsal joint implant |
L8642 |
Hallux implant |
L8658 |
Interphalangeal joint spacer |
L8659 |
Interphalangeal joint repl |
L8670 |
Vascular graft, synthetic |
L8679 |
Imp neurosti pls gn any type |
L8680 |
Implt neurostim elctr each |
L8681 |
Pt prgrm for implt neurostim |
L8682 |
Implt neurostim radiofq rec |
L8683 |
Radiofq trsmtr for implt neu |
L8684 |
Radiof trsmtr implt scrl neu |
L8685 |
Implt nrostm pls gen sng rec |
L8686 |
Implt nrostm pls gen sng non |
L8687 |
Implt nrostm pls gen dua rec |
L8688 |
Implt nrostm pls gen dua non |
L8689 |
External recharg sys intern |
L8690 |
Aud osseo dev, int/ext comp |
L8691 |
Aoi snd proc repl excl actua |
L8692 |
Non-osseointegrated snd proc |
L8693 |
Aud osseo dev, abutment |
L8694 |
Aoi transducer/actuator repl |
L8695 |
External recharg sys extern |
L8696 |
Ext antenna phren nerve stim |
L8698 |
Misc used with tot art heart |
L8699 |
Prosthetic implant nos |
L8701 |
Pow ue rom dev ewh uprt cust |
L8702 |
Pow ue rom dev ewhf uprt cus |
L9900 |
O&p supply/accessory/service |