A4561 |
Pessary, rubber, any type |
A4562 |
Pessary, nonrubber, any type |
A4565 |
Slings |
A4624 |
Tracheal suction catheter, any type than closed system, each |
A4629 |
Tracheostomy care kit |
A6258 |
Transparent film > 16 <= 48 inches |
A6402 |
Sterile gauze <= 16 square inches |
A6531 |
Compression Stockings, below the knee, 30-40 mg Hg each |
A6532 |
Compression Stockings, below the knee, 40-50 mg Hg each |
A7003 |
Administration set, with small volume nonfiltered pneumatic nebulilzer, disposable |
A7005 |
Nondisposable nebulizer set |
A7007 |
Large-volume nebulizer, disposable |
A7010 |
Disposable corrugated tubing |
A7013 |
Disposable compressor filter |
A7015 |
Aerosol mask, used with nebulizer |
A7032 |
Replacement nasal cushion |
A7034 |
Nasal application device |
A7035 |
Positive airway pressure headgear |
A7036 |
Positive airway pressure chinstrap |
A7037 |
Positive airway pressure tubing |
A7038 |
Positive airway pressure filter |
A7039 |
Filter, nondisposable with PAP |
A7046 |
Water chamber for humidifier, used with positive airway pressure device, replacement, each |
A7520 |
Tracheostomy/laryngectomy tube, non-cuffed poluvinylchloride (PVC), silicone or equal, each |
E0100 |
Cane, inc. canes of all materials, adjustable |
E0110 |
Crutch, forearm, pair |
E0114 |
Crutch, underarm, pari, no wood |
E0130 |
Walker, rigid adjustable or fixed height |
E0135 |
Walker, folding, adjustable or fixed height |
E0143 |
Walker, folding, wheeled, adjustable or fixed height |
E0147 |
Walker, heavy-duty, multiple braking system, variable wheel resistance |
E0148 |
Heavy-duty walker, no wheels |
E0149 |
Heavy-duty walker, wheeled |
E0153 |
Forearm crutch, platform attachment |
E0154 |
Walker, platform attachment |
E0155 |
Walker, wheel attachment, pair |
E0156 |
Walker, seat attachment |
E0158 |
Walker, leg extenders, (set of 4) |
E0163 |
Commode chair with fixed arms |
E0165 |
Commode chair with detached arms |
E0167 |
Commode chair, pail or pan |
E0168 |
Commode chair, extra wide &/or heavy-duty, stationary or mobile, with or without arms, any type, each |
E0188 |
Synthetic sheepskin pad |
E1081 |
APP (alternating pressure pad) mattress/overlay, powered, Group I |
E0185 |
Gel-like pressure pad for mattress, Group I |
E0199 |
Dry pressure pad for mattress |
E0202 |
Phototherapy (bilirubin) light with photometer |
E0482 |
Cough stimulating device, alternating positive & negative airway pressure |
E0500 |
IPPB machines, all types |
E0570 |
Nebulizer, with compressor |
E0560 |
Humidifier, durable, for supplemental humidification |
E0565 |
Compression, air, power source |
E0600 |
Respiratory suction pump, home model, portable or stationary, electric |
E0602 |
Breast pumps, manual |
E0603 |
Breast pumps, electric |
E0604 |
Breast pumps, hospital grade |
E0618 |
Apnea monitor without recording feature |
E0619 |
Apnea monitor with recording feature |
E0621 |
Patient lift, sling or seat |
E0630 |
Hoyer lift |
E0705 |
Transfer board or device, any type, each |
E0720 |
Tens unit, 2 leads, localized |
E0730 |
Transcutaneous electrical nerve stimulation device |
E0731 |
Form fitting conductive garment for delivery of Tens unit |
E0830 |
Ambulatory traction devices, all types |
E0840 |
Traction frame for headboard, cervical traction |
E0849 |
Traction equipment, FreestANDing frame, pneumatic, cervical |
E0850 |
Traction st, FreestANDing, cervical |
E0855 |
Cervical traction equipment not requiring additional st& or frame |
E0856 |
Cervical traction device, cervical collar with inflatable bladder |
E0860 |
Traction equipment, over door, cervical |
E0870 |
Traction, FreestANDing, extremity (e.g. Bucks) |
E0880 |
Traction, FreestANDing, extremity (e.g. Bucks) |
E0890 |
Traction frame attached to footboard, pelvic |
E0900 |
Traction st FreestANDing, pelvic |
E0910 |
Trapeze bars, aka Patient Helper, attached to bed, with grab bar |
E0911 |
Trapeze bar attached to bed with grab bar, weight greater than 250 lbs. |
E0912 |
Trapeze bar, heavy duty with grab bar, weight greater than 250 lbs., freest&ing |
E0958 |
Manual wheelchair accessory, one-arm drive attachment, each |
E0966 |
Manual wheelchair accessory, headrest extension, each |
E0968 |
Commode seat, wheelchair |
E0971 |
Manual wheelchair accessory, anti-tipping device, each |
E1020 |
Residual limb support system for wheelchair |
E1031 |
Rollabout chair, any & all types, with castors |
E1035 |
Multi-position transfer system |
E1037 |
Transport chair, pediatric size |
E1038 |
Transport chair, adult size |
E1039 |
Transport chair, adult size, heavy duty, weight greater than 300 lbs. |
E1354 |
Oxygen accessory, wheeled cart for portable cylinder or portable concentrator, any type, replacement only |
E2601 |
General use wheelchair seat cushion, width less than 22 in., any depth |
E2602 |
General use wheelchair seat cushion, width 22 in. or greater, any depth |
E2603 |
Skin protection wheelchair seat cushion, width less than 22 in., any depth |
E2604 |
Skin protection wheelchair seat cushion, width 22 in. or greater, any depth |
E2605 |
Positioning wheelchair seat cushion, width less than 22 in., any depth |
E2606 |
Positioning wheelchair seat cushion, width 22 in. or greater, any depth |
E2607 |
Skin protection & positioning wheelchair seat cushion, width less than 22 in., any depth |
E2608 |
Skin protection & positioning wheelchair seat cushion, width 22 in. or greater, any depth |
K0669 |
Wheelchair accessory, wheelchair seat or back cushion |
K0734 |
Skin protection wheelchair seat cushion, adjustable, width less than 22 in., any depth |
K0735 |
Skin protection wheelchair seat cushion, adjustable, width 22 in. or greater, any depth |
K0736 |
Skin protection & positioning wheelchair seat cushion, adjustable, width less than 22in., any depth |
K0737 |
Skin protection & positioning wheelchair seat cushion, adjustable, width 22 in. or greater, any depth |
L0112 |
Cranial-cervical orthotic |
L0120 |
Cervical, flexible, nonadjustable (foam collar) |
L0130 |
Cervical, flexible, thermoplastic collar, moded to patient |
L0140 |
Cervical, semi-rigid, adjustable, plastic collar |
L0150 |
Cervical, semi-rigid, adjustable, molded chin cup (plastic collar with m&ibular/occipital piece) |
L0160 |
Cervical, semi-rigid, wire frame occipital/m&ibular support |
L0170 |
Cervical, moded to patient |
L0172 |
Cervical, semi-rigid, thermoplastic foam, two-piece |
L0174 |
Cervical, simi-rigid, thermoplastic foam, two-piece with thoracic extenstion |
L0180 |
Cervical, multiple-post collar, occipital/m&ibular supports, adjustable |
L0190 |
Cervical, multiple post collar, occipital/m&ibular supports, adjustable cervical bars |
L0200 |
Cervical, multiple post collar, occipital/m&ibular supports, adjustable cervical bars, thoracic extension |
L0220 |
Thoracic, rib belt, custom-fabricated |
L0430 |
Dewall Posture Protector |
L0450 |
Thoracis-lumbar-sacral orthotic (TLSO), flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), inc. shoulder straps & closures, prefabricated, inc. fitting & adjustment |
L0452 |
Throacic-lumbar-sacral orthotic (TLSO), flexible, custom-fabricated |
L0454 |
Thoracic-lumbar-sacral orthotic (TLSO), flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), inc. shoulder straps & closures, prefabricated, inc. fitting & adjustment |
L0456 |
Thoracic-lumbar-sacral orthotic (TLSO), flexible, provides trunk support, thoracic region, rigid posterior panel & soft anterior apron, extends from the sacrococcygeal junction & terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, inc. straps & closures, prefabricated, inc. fitting & adjustment |
L0458 |
Thoracic-lumbar-sacral orthotic (TLSO), 2 rigid plastic shells, posterior extends from the sacrococcygeal junction & terminates just inferiror to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal & transverse planes, lateral strength is provided by overlapping plastic & stabilizing closures, inlcudes straps & closures, prefabricated, inc. fitting & adjustment |
L0460 |
Thoracic-lumbar-sacral orthotic (TLSO), 2 rigid plastic shells, posterior extends from the sacrococcygeal junction & terminates just inferiror to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal & transverse planes, lateral strength is provided by overlapping plastic & stabilizing closures, inc. straps & closures, prefabricated, inc. fitting & adjustment |
L0462 |
Thoracic-lumbar-sacral orthotic (TLSO), 3 rigid platic shells, posterior extends from the sacrococcygeal junction & terminates just inferior to the scapular spine, anterior extends from the symphysis pubis ot the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal & transverse planes, lateral strength is provided by overlapping plastic & stabilizing closures, inc. straps & closures, prefabricated, inc. fitting & adjustment |
L0464 |
Thoracic-lumbar-sacral orthotic (TLSO), 4 rigid plastic shells, posterior extends from sacrococcygeal junction & terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal & transverse planes, lateral strength is provided by overlapping plastic & stabilizing closure, inc. straps & closures, prefabricated, inc. fitting & adjustment |
L0466 |
Thoracic-lumbar-sacral orthotic (TLSO), sagittal control, rigid posterior frame, flexible soft anterior apron with straps, closures & padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, inc. fitting & shaping the frame, prefabricated, inc. fitting & adjustment |
L0468 |
Thoracic-lumbar-sacral orthotic (TLSO), sagittal-coronal control, rigid posterior frame, flexible soft anterior apron with straps, closures & padding, extends from the sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic & lateral frame pieces, restricts gross trunk motion in sagittal & coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, inc. fitting & shaping the frame, prefabricated, inc. fitting & adjustment |
L0470 |
Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, rigid posterior frame, flexible soft anterior apron with straps, closures & padding, extends from the sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic & lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal & transverse planes, produces intracavitary pressure to reduce load on the intervertebral disks, inc. fitting & shaping the frame, prefabricated, inc. fitting & adjustment |
L0472 |
Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, hyperextension, rigid anterior & lateral frame extends from symphysis pubis to sternal notch with 2 anterior componenets (one public & one sternal), posterior & lateral pads with straps & closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal & transverse planes, inc. fitting & shaping the frame, prefabricated, inc. fitting & adjustment |
L0480 |
Thoracic-lumbar-sacral orthotic (TLSO), rigid plastic, custom-fabricated |
L0482 |
Thoracic-lumbar-sacral orthotic (TLSO), triplanar control |
L0484 |
Thoracic-lumbar-sacral orthotic (TLSO), rigid plastic, custom-fabricated |
L0486 |
Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 2 piece rigid plastic shell with interface liner, multiple straps & closures, posterior extends from sacrococcygeal junction & terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal & transverse planes, inc. a carved plaster or CAD-CAM model, custom fabricated |
L0488 |
Thoracic-lumbar-sacral orthotic (TLSO), triplanar control, 1 piece rigid plastic shell with interface liner, multiple straps & closures, posterior extends from sacrococcygeal junction & terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal & transverse planes, prefabricated, inc. fitting & adjustment |
L0490 |
Thoracic-lumbar-sacral orthotic (TLSO), sagittal-coronal control, 1 piece rigid plastic shell with overlapping reinforced anterior, multiple straps & closures, posterior extends from sacrococcygeal junction & terminates at or before the T-9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal & coronal planes, prefabricated, inc. fitting & adjustment |
L0491 |
Thoracic-lumbar-sacral orthotic (TLSO), sagittal-coronal control, modular segmented spinal system, 2 rigid plastic shells, posterior extends from the sacrococcygeal junction & terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal & coronal planes, lateral strength is provided by overlapping plastic & stabilizing closures, inc. straps & closures, prefabricated, inc. fitting & adjustment |
L0492 |
TLSO, sagittal-coronal control, modular segmented spinal system, 3 rigid plastic shells, posterior extends from the sacrococcygeal junction & terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal & coronal planes, lateral strength is provided by overlapping plastic & stabilizing closures, inc. straps & closures,prefabricated, inc. fitting & adjustment |
L0621 |
Sacroiliac orthotic, flexible, provides pelvic-sacral support, reduces motion about the sacroillac joint, inc. straps & closures, may inc. pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0622 |
Sacroiliac orthotic (SIO), flexible pelvisacral, custom-fabricated |
L0623 |
Sacroiliac orthotic, provides pelvic-sacral support, with rigid or semirigid panels over the sacrum & abdomen, reduces motion about the sacroillac joint, inc. straps & closures, may inc. pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0625 |
Lumbar orthotic, flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, inc. straps, closures, may inc. pendulous abdomen design, shoulder straps, stays, prefabricated, inc. fitting & adjustment |
L0626 |
Lumbar orthotic, sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intevertebral discs, inc. straps & closures, may inc. padding, stays, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0627 |
Lumbar orthotic, sagittal control, with rigid posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, inc. straps & closures, may inc. padding, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0628 |
Lumbar-sacral orthotic (LSO), flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, inc. straps & closures, may inc. stays, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0629 |
Lumbar-sacral orthotic (LSO), flexible, provides lumbar-sacral support, posterior |
L0630 |
Lumbar-sacral orthotic (LSO), sagittal control, rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, inc. straps & closures, may inc. padding, stays, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0631 |
Lumbar-sacral orthotic (LSO), sagittal control, with rigid anterior & posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, inc. straps & closures, may inc. padding, stays, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0632 |
Lumbar-sacral orthotic (LSO), sagittal, rigid frame, custom-fabricated |
L0633 |
Lumbar-sacral orthotic (LSO), sagittal-coronal control, rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, inc. straps & closures, may inc. padding, stays, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0634 |
Lumbar-sacral orthotic (LSO), flexion control, custom-fabricated |
L0635 |
Lumbar-sacral orthotic (LSO), sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral fame/ panel(s), produces intracavitary pressure to reduce load on intervertebral discs, inc. straps & closures, may inc. padding, anterior panel, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0636 |
Lumbar-sacral orthotic (LSO), sagittal, rigid panel, custom-fabricated |
L0637 |
Lumbar-sacral orthotic (LSO), sagittal-coronal control, rigid anterior & posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, inc. straps & closures, may inc. padding, stays, shoulder straps, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0638 |
Lumbar-sacral orthotic (LSO), sagittal-coronal panel, custom-fabricated |
L0639 |
Lumbar-sacral orthotic (LSO), sagittal-coronal control, rigid shell(s)/ panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material & stabilizing closures, inc. straps & closures, may inc. soft interface, pendulous abdomen design, prefabricated, inc. fitting & adjustment |
L0640 |
Lumbar-sacral orthotic (LSO), sagittal-coronal control, with rigid shell(s) |
L0700 |
Cervical-thoracic-lumbar-sacral orthotic (CTLSO), A-P-L control, molded |
L0710 |
Cervical-thoracic-lumbar-sacral orthotic (CTLSO), A-P-L control, with interface material |
L0810 |
Halo, cervical, incorporated into jacket vest |
L0820 |
Halo, cervical, incorporated into body jacket |
L0830 |
Halo, cervical, incorporated into Milwaukee type |
L0859 |
Addition to halo procedure, magnetic resonance image compatible systems, rings & pins, any material |
L0861 |
Addition to halo procedure, replacement liner/interface material |
L0970 |
TLSO, corset front |
L0972 |
LSO, corset front |
L0974 |
TLSO, full corset |
L0976 |
LSO, full corset |
L0984 |
Protective body sock, each |
L1000 |
Cervical-thoracic-lumbar-sacral orthotic (CTLSO), Milwaukee, initial model |
L1001 |
Cervical-thoracic-lumbar-sacral orthotic (CTLSO) immobilizer, infant size, prefabricated, inc. fitting & adjustment |
L1005 |
Tension based scoliosis orthotic & accessory pads, inc. fitting & adjustment |
L1010 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, axilla sling |
L1020 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, kyphosis pad |
L1025 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, kyphosis pad floating |
L1030 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, lumbar bolster pad |
L1040 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, lumbar or lumbar rib pad |
L1050 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, sternal pad |
L1060 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, thoracic pad |
L1070 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, trapezius sling |
L1080 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, outrigger |
L1085 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, outrigger, bilateral with vertical extensions |
L1090 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, lumbar sling |
L1100 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, ring flange, plastic or leather |
L1110 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, ring flange, plastic or leather, molded to patient model |
L1120 |
Addition to cervical-thoracic-lumbar-sacral orthotic (CTLSO) or scoliosis orthotic, cover for upright, each |
L1200 |
Thoracic-lumbar-sacral-orthotic (TLSO), inclusive |
L1210 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), lateral thoracic extension |
L1220 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), anterior thoracic extension |
L1230 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO)(low profile), Milwaukee type superstructure |
L1240 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), lumbar derotation pad |
L1250 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), anterior ASIS pad |
L1260 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), anterior thoracic derotation pad |
L1270 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), abdominal pad |
L1280 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), rib gusset (elastic), each |
L1290 |
Addition to Thoracic-lumbar-sacral orthotic (TLSO) (low profile), lateral trochanteric pad |
L1300 |
Other scoliosis procedure, body jacket molded to patient model |
L1310 |
Other scoliosis procedure, postoperative body jacket |
L1500 |
Thoracic hip-knee-ankle orthotic (THKAO), mobility frame |
L1510 |
Thoracic hip-knee-ankle orthotic (THKAO), st&ing frame, with or without tray & accessories |
L1520 |
Thoracic hip-knee-ankle orthotic (THKAO), swivel walker |
L1600 |
Hip orthotic (HO), abduction control of hip joints, flexible, Frejka type with cover, prefabricated, inc. fitting & adjustment |
L1610 |
Hip orthotic (HO), abduction control of hip joints, flexible, Frejka cover only, prefabricated, inc. fitting & adjustment |
L1620 |
Hip orthotic (HO), abduction control of hip joints, flexible, Pavlik harness, prefabricated, inc. fitting & adjustment |
L1650 |
Hip orthotic, abduction control of hip joint(s), static, adjustable, (ilfled type), prefabricated, inc. fitting & adjustment |
L1652 |
Hip orthotic (HO), bilateral thigh cuffs with adjustable abductor spreader bar, adult size, prefabricated, inc. fitting & adjustment, any type |
L1660 |
Hip orthotic (HO), abduction control of hip joints, static, plastic, prefabricated, inc. fitting & adjustment |
L1686 |
Hip orthotic, abduction control of hip joint(s), postoperative hip abduction type, prefabricated, inc. fitting & adjustment |
L1690 |
Combination, bilateral, lumbo-sacral, hip, femur orthosis providing adduction & internal rotation control, prefabricated, inc. fitting & adjustment |
L1700 |
Legg perthes orthosis, Toronto type, custom-fabricated |
L1710 |
Legg perthes orthosis, Newington type, custom-fabricated |
L1720 |
Legg perthes orthosis, trilateral, Tachdijan type, custom-fabricated |
L1730 |
Legg perthes orthosis, Scottish rite type, custom-fabricated |
L1755 |
Legg perthes orthosis, patten bottom type, custom-fabricated |
L1810 |
Knee orthotic (KO), elastic, with joints, prefabricated |
L1820 |
Knee orthothic (KO), elastic, with condylar pads & joints, with or without patellar control, prefabricated, inc. fitting & adjustment |
L1830 |
Knee orthotic (KO), immobilizer, canvas longitudinal, prefabricated, inc. fitting & adjustment |
L1831 |
Knee orthotic (KO), locking knee joint(s), positional orthotic, prefabricated, inc. fitting & adjustment |
L1832 |
Knee orthotic, adjustable knee joints (unicentric or polycentric), positional orthotic, rigid support, prefabricated, inc. fitting & adjustment |
L1834 |
Knee orthotic (KO), without knee joint, rigid, custom-fabricated |
L1836 |
Knee orthotic (KO), rigid, without joint(s), inc. soft interface material, prefabricated, inc. fitting & adjustment |
L1843 |
Knee orthotic (KO), single upright, thigh & calf, with adjustable flexion & extension joint (unicentric or polycentric), medial-lateral & rotation control, with or without varus/valgus adjustment, custom fabricated |
L1845 |
Knee orthotic (KO), double upright, thigh & calf, with adjustable flexion & extension joint (unicentric or polycentric), medial-lateral & rotation control, with or without varus/valgus adjustment, prefabricated, inc. fitting & adjustment |
L1847 |
Knee orthotic (KO), double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, inc. fitting & adjustment |
L1850 |
Knee orthotic (KO), Swedish type, prefabricated, inc. fitting & adjustment |
L1900 |
Ankle-foot orthotic (AFO), spring wire, dorsiflexion assist calf b&, custom fabricated |
L1901 |
Ankle-foot orthotic (AFO), elastic, prefabricated, inc. fitting & adjustment (e.g., neoprene, Lycra) |
L1902 |
Ankle-foot orthtotic (AFO), ankle gauntlet, prefabricated, inc. fitting & adjustment |
L1904 |
Ankle-foot orthotic (AFO), molded ankle gauntlet, custom fabricated |
L1906 |
Ankle-foot orthotic (AFO), multiligamentus ankle support, prefabricated, inc. fitting & adjustment |
L1907 |
Ankle-foot orthotic (AFO), supramalleolar with straps, with or without interface/pads, custom fabricated |
L1910 |
Ankle-foot orthotic (AFO), posterior, single bar, clasp attachment to shoe counter, prefabricated, inc. fitting & adjustment |
L1920 |
Ankle-foot orthotic (AFO), single upright with static or adjustable stop (Phelps or Perlstein type), custom fabricated |
L1930 |
Ankle-foot orthotic (AFO), plastic or other material, prefabricated, inc. fitting & adjustment |
L1932 |
Ankle-foot orthotic (AFO), rigid anterior tibial section, total carbon fiber or equal material, prefabricated, inc. fitting & adjustment |
L1940 |
Ankle-foot orthotic (AFO), plastic or other material, custom fabricated |
L1945 |
Ankle-foot orthotic (AFO), plastic, rigid anterior tibial section (floor reaction), custom fabricated |
L1950 |
Ankle-foot orthotic (AFO), spiral, institute of Rehabilitative Medicine type, plastic, custom fabricated |
L1951 |
Ankle-foot orthtotic (AFO), spiral, institute of Rehabilitative Medicine type, plastic or other material, prefabricated, inc. fitting & adjustment |
L1960 |
Ankle-foot orthotic (AFO), posterior solid ankle, plastic, custom fabricated |
L1970 |
Ankle-foot orthotic (AFO), plastic with ankle joint, prefabricated, inc. fitting & adjustment |
L1971 |
Ankle-foot orthotic (AFO), plastic or other material with ankle joint, prefabricated, inc. fitting & adjustment |
L1980 |
Ankle-foot orthotic (AFO), single upright free plantar dorsiflexion, solid stirrup, calf b&/cuff (single bar ‘BK’ orthotic), custom fabricated |
L2000 |
Knee-ankle-foot-orthotic (KAFO), single upright, free knee, free ankle, solid stirrup, thigh & calf b&s/cuffs (single-bar 'ak' orthotic), custom-fabricated |
L2005 |
Knee-ankle-foot-orthotic (KAFO), any material, single or double upright, stance control, automatic lock & swing-phase release, mechanical activation, inc. ankle joint, any type, custom fabricated |
L2010 |
Knee-ankle-foot-orthotic (KAFO), single upright, free ankle, solid stirrup, thigh & calf b&s/cuffs (single bar 'ak' orthotic), without knee joint, custom-fabricated |
L2020 |
Knee-ankle-foot-orthotic (KAFO), double upright, free ankle, solid stirrup, thigh & calf b&s/cuffs (double bar 'ak' orthotic), custom-fabricated |
L2030 |
Knee-ankle-foot-orthotic (KAFO), double upright, free ankle, solid stirrup, thigh & calf b&s/cuffs, (double bar 'ak' orthotic), without knee joint, custom-fabricated |
L2034 |
Knee-ankle-foot-orthotic (KAFO), full plastic, single upright, with or without free motion knee, medial lateral rotation control, with or without free motion ankle, custom-fabricated |
L2035 |
Knee-ankle-foot orthotic (KAFO), full plastic, static, pediatric size without free motion ankle, prefabricated, inc. fitting & adjustment |
L2036 |
Knee-ankle-foot-orthotic (KAFO), full plastic, double upright, with or without free motion knee, with or without free motion ankle, custom-fabricated |
L2037 |
Knee-ankle-foot-orthotic (KAFO), full plastic, single upright, with or without free motion knee, with or without free motion ankle, custom-fabricated |
L2038 |
Hip-knee-ankle-foot-orthotic (HKAFO), full Plastic, with or without free motion knee, multi-axis ankle, custom-fabricated |
L2040 |
Hip-knee-ankle-foot-orthotic (HKAFO), torsion control, bilateral rotation straps, pelvic b&/belt, custom-fabricated |
L2050 |
Hip-knee-ankle-foot-orthotic (HKAFO), torsion control, bilateral torsion cables, hip joint, pelvic b&/belt, custom-fabricated |
L2060 |
Hip-knee-ankle-foot-orthotic (HKAFO), torsion control, bilateral torsion cables, ball bearing hip joint, pelvic b&/belt, custom-fabricated |
L2070 |
Hip,Knee, Ankle foot Orthotic/straps |
L2080 |
Hip,Knee, Ankle foot Orthotic/torsion cable |
L2090 |
Hip,Knee, Ankle foot Orthotic/torsion cable/Ball Bearing |
L2106 |
AFO/Thermo plastic casting material |
L2108 |
AFO/Custom Fabricated |
L2112 |
AFO/Soft Pre fabricated inc. fit & adjustment |
L2114 |
AFO/Semi Rigid inc. fit & adjustment |
L2116 |
AFO/Rigid pre fabricated |
L2126 |
KAFO/Thermo plastic casting material/custom |
L2128 |
KAFO/custom fabricted |
L2132 |
KAFO/soft/prefabricated |
L2134 |
KAFO/semi rigid pre fabricated |
L2136 |
KAFO/Rigig,pre fabricated |
L2180 |
Plastic shoe insert with ankle joints |
L2182 |
Orthotic drop lock knee joint |
L2184 |
limited motion knee joint |
L2186 |
Adjustable motion knee joint |
L2188 |
quadilateral brim |
L2190 |
in addition to ---waist belt |
L2200 |
Addition to lower extremityorthotic/ limited ankle motion/each joint |
L2210 |
dorsiflexion assist & plantar flexion resist/each joint |
L2220 |
Addition to lower extremityorthotic/ dorsiflexion & plantar/each joint |
L2230 |
Addition to/split flat caliper stirrups |
L2232 |
Rocker bottom for total contact ankle-foot |
L2240 |
Round caliper & plate attachment |
L2250 |
foot plate molded to patient |
L2260 |
reinforced solid stirrup |
L2265 |
long toungue stirrup |
L2270 |
varsus/valgus correction |
L2275 |
in addition to ---plastic modification |
L2280 |
Addition to/ molded inner boot |
L2300 |
Abduction bar, bilateral jointed adjustable |
L2310 |
Addition to lower extermity, abduction bar straight |
L2320 |
nonmolded lacer, for custom fabricated orthotic only |
L2330 |
lacer molded to patient model |
L2335 |
Additon to lower extremity,anterior swing b& |
L2340 |
Pretibal shell |
L2350 |
prosthetic type |
L2360 |
extended steel shank |
L2370 |
Peatten bottom |
L2375 |
torsion control, ankle joint & half solid stirrup |
L2380 |
torsion control, straight knee joint |
L2385 |
Straight knee joint heavy duty |
L2387 |
Polycentric knee joint |
L2390 |
offset knee joint |
L2395 |
offset knee joint heavy duty |
L2397 |
orthotic suspensive sleeve |
L2405 |
Drop lock each |
L2415 |
drop lock w/integrated release mech |
L2425 |
Disc or dial lock |
L2430 |
Rachet lock for active & progressive knee ext |
L2492 |
knee joint, lift loop for dy lock ring |
L2500 |
thigh weight bearing, gluteal/ischial weight |
L2510 |
thigh weight bearing, quadilateral brim, ,molded to model |
L2520 |
thigh weight bearing, quadilateral brim, ,molded to model/custom fit |
L2525 |
thigh weight bearing, ischial containment |
L2526 |
thigh weight bearing, ischial containment/custom fit |
L2530 |
Thigh weight bearing, lacer, non molded |
L2540 |
Thigh weight bearing, lacer,molded |
L2550 |
Thigh weight bearing,high roll cuff |
L2570 |
Addition to lower extemity |
L2580 |
Addition to lower extremity |
L2600 |
Addition to lower extremity |
L2610 |
addition to lower extremity |
L2620 |
pelvic control, hip joint, heavy duty, each |
L2622 |
adjustable flexion each |
L2624 |
addition to lower extremity |
L2627 |
Addition to lower extremity |
L2628 |
pelvic control, metal frame |
L2630 |
pelvic control, b& & belt |
L2640 |
pelvic control, b& & belt, bilateral |
L2650 |
pelvic & thoracic control |
L2660 |
thoracic control, thoracic b& |
L2670 |
Thoracic contol, paraspinal uprights |
L2680 |
Thoracic control, lateral supports |
L2750 |
Addition to lower extermity orthotic |
L2755 |
high strength lightweight material |
L2760 |
Orthotic Extension |
L2768 |
Orthotic side bar disconnect device |
L2770 |
Orthotic any material |
L2780 |
orthotic non corrusive finish |
L2785 |
orthotic drop lock retainer |
L2795 |
orthotic knee control |
L2800 |
Additon to lower extremity,orthotic knee control |
L2810 |
knee control, condylar pad |
L2820 |
soft interface for molded plastic |
L2830 |
orthotic soft interface |
L2840 |
Orthotic tibial length |
L2850 |
Orthotic femoral length |
L2860 |
Addition to lower extermity joint |
L3002 |
Foot, Insert, Removable, Molded To Patient Model |
L3140 |
Foot abduction rotation bar |
L3150 |
Foot abduction rotation bar/w/o shoes |
L3160 |
foot, adjustable shoe style positioning device |
L3170 |
Foot plastic silicone or equal heel stabilizer |
L3202 |
Oxford w/ supinat/pronator c |
L3208 |
Surgical boot infant |
L3209 |
Surgical boot child |
L2311 |
Surgical boot Junior |
L2312 |
Benesch boot pair infant |
L3213 |
Benesch boot pair child |
L3214 |
Benesch boot pair junior |
L3224 |
Woman's shoe oxford brace |
L3225 |
Man's shoe oxford brace |
L3260 |
Surgical boot/shoe each |
L3265 |
Pastazote s&al each |
L3300 |
lift,elveation heel |
L3310 |
lift,elveation heel & sole neoprene per inch |
L3320 |
Lift elevation heel & sole cork per inch |
L3332 |
Lift elevation inside shoe tapered |
L3334 |
Lift elevation heel per inch |
L3340 |
Heel wedge, solid ankle heel cusion |
L3350 |
Heel wedge |
L3360 |
Sole wedge outside sole |
L3370 |
Sole wedge between sole |
L3380 |
Club foot wedge |
L3390 |
Outflare Wedge |
L3400 |
Metatarsal bar wedge |
L3410 |
Metatarsal bar wedge |
L3420 |
Full sole & heel wedge |
L3430 |
Heel Counter |
L3440 |
Heel Counter |
L3450 |
Heel solid ankle cushion |
L3455 |
Heel new leather |
L3460 |
Heel new rubber |
L3465 |
Heel thomas with wedge |
L3470 |
Heel thomas extended |
L3480 |
Heel pad |
L3485 |
Heel pad |
L3500 |
Orthopedic shoe addition insole |
L3510 |
Orthopedic shoe addition insole |
L3520 |
Orthopedic shoe addition insole |
L3530 |
Orthopedic shoe addition sole |
L3540 |
Orthopedic shoe addition sole |
L3550 |
Orthopedic shoe addition toe tap |
L3560 |
Orthopedic shoe addition toe tap |
L3570 |
Orthopedic shoe addition special extension |
L3580 |
Orthopedic shoe ext. conert instep |
L3590 |
Orthopedic shoe insert, firm to soft |
L3595 |
orthopedic shoe addition, march bar |
L3600 |
Transfer of orthotic caliper plate |
L3610 |
Transfer of orthotic caliper plate |
L3620 |
Transfer of orthotic Solid stirrup |
L3630 |
Transfer of orthotic Solid stirrup |
L3640 |
Transfer of orthotic dennis brown splint |
L3649 |
Orthopedic shoe modification |
L3650 |
Shoulder Orthotic |
L3652 |
Shoulder Orthotic |
L3660 |
Shoulder Orthotic |
L3670 |
Shoulder Orthotic |
L3671 |
Shoulder Orthotic |
L3672 |
Shoulder Orthotic |
L3673 |
Shoulder Orthotic/abduction positioning |
L3675 |
Shoulder Orthotic/vest type |
L3677 |
Shoulder Orthotic/hard plastic |
L3701 |
Elbow Orthotic, elastic, pre fabricated |
L3710 |
Elbow Orthotic, elastic with metal joints |
L3760 |
Ellow Orthotic, w/adjustable position locking joints |
L3762 |
Elbow Orthotic, rigid, w/o joints |
L3765 |
Elbow wrist h& finger orthotic |
L3766 |
Elbow wrist h& finger orthotic w/one or more montorsion joint |
L3806 |
WHFO non torsion joints, elastic b&s, turnbuckles |
L3807 |
WHFO without joints pre-fabricated |
L3808 |
WHFO rigid may inc. soft interface material, straps |
L3905 |
WHO with non torsion joints elastic b&s turnbuckles |
L3906 |
WHO w/o Joints, may inc. soft interface, straps |
L3908 |
WHO wrist ext control cock-up, non molded, pre fabricated |
L3909 |
WO elastic, pre fabricated, inc. fitting |
L3911 |
WHFO flexion glove with elastic finger |
L3913 |
HFO without joints custom fabricated |
L3915 |
WHO inc. one or more nontorsion joint |
L3917 |
HO metacarpal fracture orthotic |
L3919 |
HFO without joints custom fabricated |
L3921 |
HFO with joints custom fabricated |
L3923 |
HFO, without joints soft interface straps |
L3925 |
FO proximal PIP without joint/spring extension/flexion |
L3927 |
FO distal DIP w/o joint, spring, ext/flexion |
L3929 |
HFO inc. one or more nontorsion joints, turnbuckles |
L3931 |
HFO inc. one or more nontorsion joints, turnbuckles |
L3932 |
FO safety pin |
L3933 |
FO without joints custom fabricated |
L3934 |
FO safety pin |
L3935 |
FO nontorsion joint custom fabricated |
L3956 |
Additon of upper joint to upper extermity orthotic |
L3960 |
Shoulder elbow wrist h& orthotic |
L3961 |
SEWHO shoulder cap design w/o joints |
L3962 |
SEWHO abduction positioning |
L3964 |
SEO mobile arm support attached to wheelchair |
L3965 |
SEO mobile arm support attached to wheelchair balanced adjustable |
L3966 |
SEO mobile arm support attached to wheelchair balanced reclining |
L3967 |
SEWHO airplane design without joints custom fabricated |
L3968 |
SEO mobile arm support attached to wheelchair balanced friction arm |
L3969 |
SEO mobile arm support monosuspension arm & h& support |
L3971 |
SEWHO cap design with joints |
L3973 |
SEWHO airplane design without joints custom fabricated |
L3975 |
SEWHO shoulder cap design w/o joints |
L3976 |
SEWHO airplane design without joints custom fabricated |
L3977 |
SEWHO shoulder cap design inc. nontorsion joints |
L3978 |
SEWHO airplane design thoracic component |
L3980 |
Upper extremity orthotic, humeral, prefabricated |
L3982 |
Upper extremity fracture orthotic |
L3984 |
Upper extremity fracture orthotic, wrist, prefabricated |
L3995 |
Addition to upper extremity orthotic, sock |
L4000 |
Replace girdle for spinal orthotic |
L4045 |
Replace non molded thigh lacer, custom fabricated |
L4050 |
Replace molded calf lacer, custom fabricated |
L4055 |
Replace non molded calf lacer, custom fabricated |
L4060 |
Replace high roll cuff |
L4070 |
Replace proximal & distal upright for KAFO |
L4080 |
Replace metal b&s KAFO proximal thigh |
L4090 |
Replace metal b&s KAFO or AFO |
L4100 |
Replace leather KAFO proximal thigh |
L4110 |
Replace leather KAFO-AFO calf or distal thigh |
L4130 |
Replace pretibial shell |
L4205 |
Repair of orthotic device, labor component per 15 mins |
L4210 |
Repair of orthotic device, repair or replace minor parts |
L4350 |
Ankle control orthotic stirrup style, rigid |
L4360 |
Walking boot, pneumatic with or w/o joints |
L4370 |
Pneumatic full leg splint, pre fabricated |
L4380 |
Pneumatic knee splint pre fabricated |
L4386 |
Walking boot, nonpneumatic with or without joints |
L4392 |
Replacement soft interface material |
L4394 |
Replace soft interface material, foot drop splint |
L4396 |
AFO including soft inerface material, adjustable for fit |
L4398 |
Foot drop splint, recumbent positioning device, prefabricated, inc. fitting & adjustment |
L5000 |
Partial foot, shoe insert with longitudinal arch, toe filler |
L5010 |
Partial foot, molded socket, ankle height, with toe filler |
L5020 |
Partial foot, molded socket, tibial tubercle height, with toe filler |
L5510 |
Preparatory, below knee Patellar-tendon bearing (PTB) type socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, plaster socket, molded to model |
L5520 |
Preparatory, below knee Patellar-tendon bearing (PTB) type socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, thermoplastic or equal, direct formed |
L5530 |
Preparatory, below knee Patellar-tendon bearing (PTB) type socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, thermoplastic or equal, molded to model |
L5535 |
Preparatory, below knee Patellar-tendon bearing (PTB) type socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, prefabricated, adjustable open end socket |
L5540 |
Preparatory, below knee Patellar-tendon bearing (PTB) type socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, laminated socket, molded to model |
L5560 |
Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, plaster socket, molded to model |
L5570 |
Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, thermoplastic or equal, direct formed |
L5580 |
Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, thermoplastic or equal, molded to model |
L5585 |
Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, prefabricated adjustable open end socket |
L5590 |
Preparatory, above knee, knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, Solid ankle cushion heal (SACH) foot, laminated socket, molded to model |
L5595 |
Preparatory, hip disarticulation/hemipelevectomy, pylon, no cover, Solid ankle cushion heal (SACH) foot, thermoplastic or equal, molded to patient model |
L5600 |
Preparatory, hip disarticulation/hemipelevectomy, pylon, no cover, Solid ankle cushion heal (SACH) foot, laminated socket, molded to patient model |
L5673 |
Addition to lower extremity, below knee/above knee, customfabricated from existing mold or prefabricated, socket insert, silicone gel, elastometric or equal, for use with locking mechanism |
L8000 |
Breast prosthesis, mastectomy bra |
L8010 |
Breast prosthesis, mastectomy sleeve |
L8030 |
Breast prosthesis, silicone or equal |
L8300 |
Truss, single with st&ard pad |
L8310 |
Truss, double with st&ard pads |
L8420 |
Prosthetic sock, multiple ply, below knee, each |
L8440 |
Prosthetic shrinker, below knee, each |
L8460 |
Prosthetic shrinker, above knee, each |
L8470 |
Prosthetic sock, single ply, fitting, below knee |
L8501 |
Tracheostomy speaking valve |
L8505 |
Artificial larynx replacement battery |
L8507 |
Tracheoesophageal voice prosthesis, patient inserted, any type, each |
L8509 |
Tracheo-esoph voice pros |
L8618 |
Transmitter cable for use with cochlear implant device, replacement |
L8621 |
Zinc air battery for use with cochlear implant device, replacement, each |
L8624 |
Lithium ion battery for use with cochlear implant speech processor, ear level, replacement, each |
V2523 |
Contact lens, hydrophilic, extended wear, per lens (Keratoconus) |
V2624 |
Polishing/resurfacing of ocular prosthesis |
V5014 |
Repair/modification of a hearing aid |
A4605 |
Tracheal suction catheter, closed system, each |
A6501 |
Compression burn garment, bodysuit (head to foot), custom fabricated |
A6502 |
Compression burn garment, chin strap, custom fabricated |
A6503 |
Compression burn garment, facial hood, custom fabricated |
A6504 |
Compression burn garment, glove to wrist, custom fabricated |
A6505 |
Compression burn garment, glove to elbow, custom fabricated |
A6506 |
Compression burn garment, glove to axilla, custom fabricated |
A6507 |
Compression burn garment, foot to knee length, custom fabricated |
A6508 |
Compression burn garment, foot to thigh length, custom fabricated |
A6509 |
Compression burn garment, upper trunk to waist, including arm openings (vest), custom fabricated |
A6510 |
Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated |
A6511 |
Compression burn garment, lower trunk, including leg openings (panty), custom fabricated |
A6512 |
Compression burn garment, not otherwise specified |
A6513 |
Compression burn mask, face &/or neck, plastic or equal, custom fabricated |