Default Fee Schedule Part 5

Default Fee Schedule Part 5

CodePriceTypeDescription
K00110HCPCS / CPT®STND WT PWR WHLCHR W CONTROL
K00120HCPCS / CPT®LTWT PORTBL POWER WHLCHR
K00130HCPCS / CPT®CUSTOM POWER WHLCHR BASE
K00140HCPCS / CPT®OTHER POWER WHLCHR BASE
K00150HCPCS / CPT®DETACH NON-ADJ HT ARMRST REP
K00170HCPCS / CPT®DETACH ADJUST ARMREST BASE
K00180HCPCS / CPT®DETACH ADJUST ARMRST UPPER
K00190HCPCS / CPT®ARM PAD REPL, EACH
K00200HCPCS / CPT®FIXED ADJUST ARMREST PAIR
K00370HCPCS / CPT®HI MOUNT FLIP-UP FTREST REPL
K00380HCPCS / CPT®LEG STRAP EACH
K00390HCPCS / CPT®LEG STRAP H STYLE EACH
K00400HCPCS / CPT®ADJUSTABLE ANGLE FOOTPLATE
K00410HCPCS / CPT®LARGE SIZE FOOTPLATE EACH
K00420HCPCS / CPT®STANDARD SIZE FTPLATE REP EA
K00430HCPCS / CPT®FTRST LOWR EXTEN TUBE REP EA
K00440HCPCS / CPT®FTRST UPR HANGER BRAC REP EA
K00450HCPCS / CPT®FTRST COMPL ASSEMBLY REPL EA
K00460HCPCS / CPT®ELEV LGRST LWR EXTEN REPL EA
K00470HCPCS / CPT®ELEV LEGRST UPR HANGR REP EA
K00500HCPCS / CPT®RATCHET ASSEMBLY REPLACEMENT
K00510HCPCS / CPT®CAM REL ASM FT/LEGRST REP EA
K00520HCPCS / CPT®SWINGAWAY DETACH FTREST REPL
K00530HCPCS / CPT®ELEVATE FOOTREST ARTICULATE
K00560HCPCS / CPT®SEAT HT <17 OR >=21 LTWT WC
K00650HCPCS / CPT®SPOKE PROTECTORS
K00690HCPCS / CPT®RR WHL COMPL SOL TIRE REP EA
K00700HCPCS / CPT®RR WHL COMPL PNE TIRE REP EA
K00710HCPCS / CPT®FR CSTR COMP PNE TIRE REP EA
K00720HCPCS / CPT®FR CSTR SEMI-PNE TIRE REP EA
K00730HCPCS / CPT®CASTER PIN LOCK EACH
K00770HCPCS / CPT®FR CSTR ASMB SOL TIRE REP EA
K00980HCPCS / CPT®DRIVE BELT FOR PWC, REPL
K01050HCPCS / CPT®IV HANGER
K01080HCPCS / CPT®W/C COMPONENT-ACCESSORY NOS
K01950HCPCS / CPT®ELEVATING WHLCHAIR LEG RESTS
K04550HCPCS / CPT®PUMP UNINTERRUPTED INFUSION
K04620HCPCS / CPT®TEMPORARY REPLACEMENT EQPMNT
K05520HCPCS / CPT®SUP/EXT NON-INS INF PUMP SYR
K06010HCPCS / CPT®REPL BATT SILVER OXIDE 1.5 V
K06020HCPCS / CPT®REPL BATT SILVER OXIDE 3 V
K06030HCPCS / CPT®REPL BATT ALKALINE 1.5 V
K06040HCPCS / CPT®REPL BATT LITHIUM 3.6 V
K06050HCPCS / CPT®REPL BATT LITHIUM 4.5 V
K06060HCPCS / CPT®AED GARMENT W ELEC ANALYSIS
K06070HCPCS / CPT®REPL BATT FOR AED
K06080HCPCS / CPT®REPL GARMENT FOR AED
K06090HCPCS / CPT®REPL ELECTRODE FOR AED
K06690HCPCS / CPT®SEAT/BACK CUS NO DMEPDAC VER
K06720HCPCS / CPT®REMOVABLE SOFT INTERFACE LE
K07300HCPCS / CPT®CTRL DOSE INH DRUG DELIV SYS
K07330HCPCS / CPT®12-24HR SEALED LEAD ACID
K07380HCPCS / CPT®PORTABLE GAS OXYGEN SYSTEM
K07390HCPCS / CPT®REPAIR/SVC DME NON-OXYGEN EQ
K07400HCPCS / CPT®REPAIR/SVC OXYGEN EQUIPMENT
K07430HCPCS / CPT®PORTABLE HOME SUCTION PUMP
K07440HCPCS / CPT®ABSORP DRG <= 16 SUC PUMP
K07450HCPCS / CPT®ABSORP DRG >16<=48 SUC PUMP
K07460HCPCS / CPT®ABSORP DRG >48 SUC PUMP
K08000HCPCS / CPT®POV GROUP 1 STD UP TO 300LBS
K08010HCPCS / CPT®POV GROUP 1 HD 301-450 LBS
K08020HCPCS / CPT®POV GROUP 1 VHD 451-600 LBS
K08060HCPCS / CPT®POV GROUP 2 STD UP TO 300LBS
K08070HCPCS / CPT®POV GROUP 2 HD 301-450 LBS
K08080HCPCS / CPT®POV GROUP 2 VHD 451-600 LBS
K08120HCPCS / CPT®POWER OPERATED VEHICLE NOC
K08130HCPCS / CPT®PWC GP 1 STD PORT SEAT/BACK
K08140HCPCS / CPT®PWC GP 1 STD PORT CAP CHAIR
K08150HCPCS / CPT®PWC GP 1 STD SEAT/BACK
K08160HCPCS / CPT®PWC GP 1 STD CAP CHAIR
K08200HCPCS / CPT®PWC GP 2 STD PORT SEAT/BACK
K08210HCPCS / CPT®PWC GP 2 STD PORT CAP CHAIR
K08220HCPCS / CPT®PWC GP 2 STD SEAT/BACK
K08230HCPCS / CPT®PWC GP 2 STD CAP CHAIR
K08240HCPCS / CPT®PWC GP 2 HD SEAT/BACK
K08250HCPCS / CPT®PWC GP 2 HD CAP CHAIR
K08260HCPCS / CPT®PWC GP 2 VHD SEAT/BACK
K08270HCPCS / CPT®PWC GP VHD CAP CHAIR
K08280HCPCS / CPT®PWC GP 2 XTRA HD SEAT/BACK
K08290HCPCS / CPT®PWC GP 2 XTRA HD CAP CHAIR
K08300HCPCS / CPT®PWC GP2 STD SEAT ELEVATE S/B
K08310HCPCS / CPT®PWC GP2 STD SEAT ELEVATE CAP
K08350HCPCS / CPT®PWC GP2 STD SING POW OPT S/B
K08360HCPCS / CPT®PWC GP2 STD SING POW OPT CAP
K08370HCPCS / CPT®PWC GP 2 HD SING POW OPT S/B
K08380HCPCS / CPT®PWC GP 2 HD SING POW OPT CAP
K08390HCPCS / CPT®PWC GP2 VHD SING POW OPT S/B
K08400HCPCS / CPT®PWC GP2 XHD SING POW OPT S/B
K08410HCPCS / CPT®PWC GP2 STD MULT POW OPT S/B
K08420HCPCS / CPT®PWC GP2 STD MULT POW OPT CAP
K08430HCPCS / CPT®PWC GP2 HD MULT POW OPT S/B
K08480HCPCS / CPT®PWC GP 3 STD SEAT/BACK
K08490HCPCS / CPT®PWC GP 3 STD CAP CHAIR
K08500HCPCS / CPT®PWC GP 3 HD SEAT/BACK
K08510HCPCS / CPT®PWC GP 3 HD CAP CHAIR
K08520HCPCS / CPT®PWC GP 3 VHD SEAT/BACK
K08530HCPCS / CPT®PWC GP 3 VHD CAP CHAIR
K08540HCPCS / CPT®PWC GP 3 XHD SEAT/BACK
K08550HCPCS / CPT®PWC GP 3 XHD CAP CHAIR
K08560HCPCS / CPT®PWC GP3 STD SING POW OPT S/B
K08570HCPCS / CPT®PWC GP3 STD SING POW OPT CAP
K08580HCPCS / CPT®PWC GP3 HD SING POW OPT S/B
K08590HCPCS / CPT®PWC GP3 HD SING POW OPT CAP
K08600HCPCS / CPT®PWC GP3 VHD SING POW OPT S/B
K08610HCPCS / CPT®PWC GP3 STD MULT POW OPT S/B
K08620HCPCS / CPT®PWC GP3 HD MULT POW OPT S/B
K08630HCPCS / CPT®PWC GP3 VHD MULT POW OPT S/B
K08640HCPCS / CPT®PWC GP3 XHD MULT POW OPT S/B
K08680HCPCS / CPT®PWC GP 4 STD SEAT/BACK
K08690HCPCS / CPT®PWC GP 4 STD CAP CHAIR
K08700HCPCS / CPT®PWC GP 4 HD SEAT/BACK
K08710HCPCS / CPT®PWC GP 4 VHD SEAT/BACK
K08770HCPCS / CPT®PWC GP4 STD SING POW OPT S/B
K08780HCPCS / CPT®PWC GP4 STD SING POW OPT CAP
K08790HCPCS / CPT®PWC GP4 HD SING POW OPT S/B
K08800HCPCS / CPT®PWC GP4 VHD SING POW OPT S/B
K08840HCPCS / CPT®PWC GP4 STD MULT POW OPT S/B
K08850HCPCS / CPT®PWC GP4 STD MULT POW OPT CAP
K08860HCPCS / CPT®PWC GP4 HD MULT POW S/B
K08900HCPCS / CPT®PWC GP5 PED SING POW OPT S/B
K08910HCPCS / CPT®PWC GP5 PED MULT POW OPT S/B
K08980HCPCS / CPT®POWER WHEELCHAIR NOC
K08990HCPCS / CPT®POW MOBIL DEV NO DMEPDAC
K09000HCPCS / CPT®CSTM DME OTHER THAN WHEELCHR
L01120HCPCS / CPT®CRANIAL CERVICAL ORTHOSIS
L01130HCPCS / CPT®CRANIAL CERVICAL TORTICOLLIS
L01200HCPCS / CPT®CERV FLEX N/ADJ FOAM PRE OTS
L01300HCPCS / CPT®FLEX THERMOPLASTIC COLLAR MO
L01400HCPCS / CPT®CERVICAL SEMI-RIGID ADJUSTAB
L01500HCPCS / CPT®CERV SEMI-RIG ADJ MOLDED CHN
L01600HCPCS / CPT®CERV SR WIRE OCC/MAN PRE OTS
L01700HCPCS / CPT®CERVICAL COLLAR MOLDED TO PT
L017237HCPCS / CPT®CERV COL SR FOAM 2PC PRE OTS
L01740HCPCS / CPT®CERV SR 2PC THOR EXT PRE OTS
L01800HCPCS / CPT®CER POST COL OCC/MAN SUP ADJ
L01900HCPCS / CPT®CERV COLLAR SUPP ADJ CERV BA
L02000HCPCS / CPT®CERV COL SUPP ADJ BAR & THOR
L02200HCPCS / CPT®THOR RIB BELT CUSTOM FABRICA
L04500HCPCS / CPT®TLSO FLEX TRUNK/THOR PRE OTS
L04520HCPCS / CPT®TLSO FLEX CUSTOM FAB THORACI
L04540HCPCS / CPT®TLSO TRNK SJ-T9 PRE CST
L04550HCPCS / CPT®TLSO FLEX TRNK SJ-T9 PRE OTS
L04560HCPCS / CPT®TLSO FLEX TRNK SJ-SS PRE CST
L04570HCPCS / CPT®TLSO FLEX TRNK SJ-SS PRE OTS
L04580HCPCS / CPT®TLSO 2MOD SYMPHIS-XIPHO PRE
L04600HCPCS / CPT®TLSO 2 SHL SYMPHYS-STERN CST
L04620HCPCS / CPT®TLSO 3MOD SACRO-SCAP PRE
L04640HCPCS / CPT®TLSO 4MOD SACRO-SCAP PRE
L04660HCPCS / CPT®TLSO R FRAM SOFT ANT PRE CST
L04670HCPCS / CPT®TLSO R FRAM SOFT PRE OTS
L04680HCPCS / CPT®TLSO RIG FRAM PELVIC PRE CST
L04690HCPCS / CPT®TLSO RIG FRAM PELVIC PRE OTS
L04700HCPCS / CPT®TLSO RIGID FRAME PRE SUBCLAV
L04720HCPCS / CPT®TLSO RIGID FRAME HYPEREX PRE
L04800HCPCS / CPT®TLSO RIGID PLASTIC CUSTOM FA
L04820HCPCS / CPT®TLSO RIGID LINED CUSTOM FAB
L04840HCPCS / CPT®TLSO RIGID PLASTIC CUST FAB
L04860HCPCS / CPT®TLSO RIGIDLINED CUST FAB TWO
L04880HCPCS / CPT®TLSO RIGID LINED PRE ONE PIE
L04900HCPCS / CPT®TLSO RIGID PLASTIC PRE ONE
L04910HCPCS / CPT®TLSO 2 PIECE RIGID SHELL
L04920HCPCS / CPT®TLSO 3 PIECE RIGID SHELL
L06210HCPCS / CPT®SIO FLEX PELVIC/SACR PRE OTS
L06220HCPCS / CPT®SIO FLEX PELVISACRAL CUSTOM
L06230HCPCS / CPT®SIO RIG PNL PELV/SAC PRE OTS
L06240HCPCS / CPT®SIO PANEL CUSTOM
L06250HCPCS / CPT®LO FLEX L1-BELOW L5 PRE OTS
L06260HCPCS / CPT®LO SAG RIG PNL STAYS PRE CST
L06270HCPCS / CPT®LO SAG RI AN/POS PNL PRE CST
L06280HCPCS / CPT®LSO FLEX NO RI STAYS PRE OTS
L06290HCPCS / CPT®LSO FLEX W/RIGID STAYS CUST
L06300HCPCS / CPT®LSO R POST PNL SJ-T9 PRE CST
L06310HCPCS / CPT®LSO SAG R AN/POS PNL PRE CST
L06320HCPCS / CPT®LSO SAG RIGID FRAME CUST
L06330HCPCS / CPT®LSO SC R POS/LAT PNL PRE CST
L06340HCPCS / CPT®LSO FLEXION CONTROL CUSTOM
L06350HCPCS / CPT®LSO SAGIT RIGID PANEL PREFAB
L06360HCPCS / CPT®LSO SAGITTAL RIGID PANEL CUS
L06370HCPCS / CPT®LSO SC R ANT/POS PNL PRE CST
L06380HCPCS / CPT®LSO SAG-CORONAL PANEL CUSTOM
L06390HCPCS / CPT®LSO S/C SHELL/PANEL PREFAB
L06400HCPCS / CPT®LSO S/C SHELL/PANEL CUSTOM
L06410HCPCS / CPT®LO RIG POS PNL L1-L5 PRE OTS
L06420HCPCS / CPT®LO SAG RI AN/POS PNL PRE OTS
L06430HCPCS / CPT®LSO SAG CTR RIGI POS PRE OTS
L06480HCPCS / CPT®LSO SAG R AN/POS PNL PRE OTS
L06490HCPCS / CPT®LSO SC R POS/LAT PNL PRE OTS
L06500HCPCS / CPT®LSO SC R ANT/POS PNL PRE OTS
L06510HCPCS / CPT®LSO SAG-CO SHELL PNL PRE OTS
L07000HCPCS / CPT®CTLSO A-P-L CONTROL MOLDED
L07100HCPCS / CPT®CTLSO A-P-L CONTROL W/ INTER
L08100HCPCS / CPT®HALO CERVICAL INTO JCKT VEST
L08200HCPCS / CPT®HALO CERVICAL INTO BODY JACK
L08300HCPCS / CPT®HALO CERV INTO MILWAUKEE TYP
L08590HCPCS / CPT®MRI COMPATIBLE SYSTEM
L08610HCPCS / CPT®HALO REPL LINER/INTERFACE
L09700HCPCS / CPT®TLSO CORSET FRONT
L09720HCPCS / CPT®LSO CORSET FRONT
L09740HCPCS / CPT®TLSO FULL CORSET
L09760HCPCS / CPT®LSO FULL CORSET
L09780HCPCS / CPT®AXILLARY CRUTCH EXTENSION
L09800HCPCS / CPT®PERONEAL STRAPS PAIR PRE OTS
L09820HCPCS / CPT®STOCKING SUP GRIPS 4 PRE OTS
L09840HCPCS / CPT®PROTECT BODY SOCK EA PRE OTS
L09990HCPCS / CPT®ADD TO SPINAL ORTHOSIS NOS
L10000HCPCS / CPT®CTLSO MILWAUKE INITIAL MODEL
L10010HCPCS / CPT®CTLSO INFANT IMMOBILIZER
L10050HCPCS / CPT®TENSION BASED SCOLIOSIS ORTH
L10100HCPCS / CPT®CTLSO AXILLA SLING
L10200HCPCS / CPT®KYPHOSIS PAD
L10250HCPCS / CPT®KYPHOSIS PAD FLOATING
L10300HCPCS / CPT®LUMBAR BOLSTER PAD
L10400HCPCS / CPT®LUMBAR OR LUMBAR RIB PAD
L10500HCPCS / CPT®STERNAL PAD
L10600HCPCS / CPT®THORACIC PAD
L10700HCPCS / CPT®TRAPEZIUS SLING
L10800HCPCS / CPT®OUTRIGGER
L10850HCPCS / CPT®OUTRIGGER BIL W/ VERT EXTENS
L10900HCPCS / CPT®LUMBAR SLING
L11000HCPCS / CPT®RING FLANGE PLASTIC/LEATHER
L11100HCPCS / CPT®RING FLANGE PLAS/LEATHER MOL
L11200HCPCS / CPT®COVERS FOR UPRIGHT EACH
L12000HCPCS / CPT®FURNSH INITIAL ORTHOSIS ONLY
L12100HCPCS / CPT®LATERAL THORACIC EXTENSION
L12200HCPCS / CPT®ANTERIOR THORACIC EXTENSION
L12300HCPCS / CPT®MILWAUKEE TYPE SUPERSTRUCTUR
L12400HCPCS / CPT®LUMBAR DEROTATION PAD
L12500HCPCS / CPT®ANTERIOR ASIS PAD
L12600HCPCS / CPT®ANTERIOR THORACIC DEROTATION
L12700HCPCS / CPT®ABDOMINAL PAD
L12800HCPCS / CPT®RIB GUSSET (ELASTIC) EACH
L12900HCPCS / CPT®LATERAL TROCHANTERIC PAD
L13000HCPCS / CPT®BODY JACKET MOLD TO PATIENT
L13100HCPCS / CPT®POST-OPERATIVE BODY JACKET
L14990HCPCS / CPT®SPINAL ORTHOSIS NOS
L16000HCPCS / CPT®HO FLEX FREJKA W/COV PRE CST
L16100HCPCS / CPT®HO FREJKA COV ONLY PRE CST
L16200HCPCS / CPT®HO FLEX PAVLIK HARNS PRE CST
L16300HCPCS / CPT®ABDUCT CONTROL HIP SEMI-FLEX
L16400HCPCS / CPT®PELV BAND/SPREAD BAR THIGH C
L16500HCPCS / CPT®HO ABDUCTION HIP ADJUSTABLE
L16520HCPCS / CPT®HO BI THIGHCUFFS W SPRDR BAR
L16600HCPCS / CPT®HO ABDUCTION STATIC PLASTIC
L16800HCPCS / CPT®PELVIC & HIP CONTROL THIGH C
L16850HCPCS / CPT®POST-OP HIP ABDUCT CUSTOM FA
L16860HCPCS / CPT®HO POST-OP HIP ABDUCTION
L16900HCPCS / CPT®COMBINATION BILATERAL HO
L17000HCPCS / CPT®LEG PERTHES ORTH TORONTO TYP
L17100HCPCS / CPT®LEGG PERTHES ORTH NEWINGTON
L17200HCPCS / CPT®LEGG PERTHES ORTHOSIS TRILAT
L17300HCPCS / CPT®LEGG PERTHES ORTH SCOTTISH R
L17550HCPCS / CPT®LEGG PERTHES PATTEN BOTTOM T
L18100HCPCS / CPT®KO ELASTIC WITH JOINTS
L18120HCPCS / CPT®KO ELASTIC W/JOINTS PRE OTS
L18200HCPCS / CPT®KO ELAS W/ CONDYLE PADS & JO
L183042HCPCS / CPT®KO IMMOB CANVAS LONG PRE OTS
L18310HCPCS / CPT®KNEE ORTH POS LOCKING JOINT
L18320HCPCS / CPT®KO ADJ JNT POS R SUP PRE CST
L18330HCPCS / CPT®KO ADJ JNT POS R SUP PRE OTS
L18340HCPCS / CPT®KO W/0 JOINT RIGID MOLDED TO
L18360HCPCS / CPT®KO RIGID W/O JOINTS PRE OTS
L18400HCPCS / CPT®KO DEROT ANT CRUCIATE CUSTOM
L18430HCPCS / CPT®KO SINGLE UPRIGHT PRE CST
L18440HCPCS / CPT®KO W/ADJ JT ROT CNTRL MOLDED
L18450HCPCS / CPT®KO DOUBLE UPRIGHT PRE CST
L18460HCPCS / CPT®KO W ADJ FLEX/EXT ROTAT MOLD
L18470HCPCS / CPT®KO DBL UPRIGHT W/AIR PRE CST
L18480HCPCS / CPT®KO DBL UPRIGHT W/AIR PRE OTS
L18500HCPCS / CPT®KO SWEDISH TYPE PRE OTS
L18510HCPCS / CPT®KO SINGLE UPRIGHT PREFAB OTS
L18520HCPCS / CPT®KO DOUBLE UPRIGHT PREFAB OTS
L18600HCPCS / CPT®KO SUPRACONDYLAR SOCKET MOLD
L19000HCPCS / CPT®AFO SPRNG WIR DRSFLX CALF BD
L19020HCPCS / CPT®AFO ANKLE GAUNTLET PRE OTS
L19040HCPCS / CPT®AFO MOLDED ANKLE GAUNTLET
L1906121HCPCS / CPT®AFO MULTILIG ANK SUP PRE OTS
L19070HCPCS / CPT®AFO SUPRAMALLEOLAR CUSTOM
L19100HCPCS / CPT®AFO SING BAR CLASP ATTACH SH
L19200HCPCS / CPT®AFO SING UPRIGHT W/ ADJUST S
L19300HCPCS / CPT®AFO PLASTIC
L19320HCPCS / CPT®AFO RIG ANT TIB PREFAB TCF/=
L19400HCPCS / CPT®AFO MOLDED TO PATIENT PLASTI
L19450HCPCS / CPT®AFO MOLDED PLAS RIG ANT TIB
L19500HCPCS / CPT®AFO SPIRAL MOLDED TO PT PLAS
L19510HCPCS / CPT®AFO SPIRAL PREFABRICATED
L19600HCPCS / CPT®AFO POS SOLID ANK PLASTIC MO
L19700HCPCS / CPT®AFO PLASTIC MOLDED W/ANKLE J
L19710HCPCS / CPT®AFO W/ANKLE JOINT, PREFAB
L19800HCPCS / CPT®AFO SING SOLID STIRRUP CALF
L19900HCPCS / CPT®AFO DOUB SOLID STIRRUP CALF
L20000HCPCS / CPT®KAFO SING FRE STIRR THI/CALF
L20050HCPCS / CPT®KAFO SNG/DBL MECHANICAL ACT
L20100HCPCS / CPT®KAFO SNG SOLID STIRRUP W/O J
L20200HCPCS / CPT®KAFO DBL SOLID STIRRUP BAND/
L20300HCPCS / CPT®KAFO DBL SOLID STIRRUP W/O J
L20340HCPCS / CPT®KAFO PLA SIN UP W/WO K/A CUS
L20350HCPCS / CPT®KAFO PLASTIC PEDIATRIC SIZE
L20360HCPCS / CPT®KAFO PLAS DOUB FREE KNEE MOL
L20370HCPCS / CPT®KAFO PLAS SING FREE KNEE MOL
L20380HCPCS / CPT®KAFO W/O JOINT MULTI-AXIS AN
L20400HCPCS / CPT®HKAFO TORSION BIL ROT STRAPS
L20500HCPCS / CPT®HKAFO TORSION CABLE HIP PELV
L20600HCPCS / CPT®HKAFO TORSION BALL BEARING J
L20700HCPCS / CPT®HKAFO TORSION UNILAT ROT STR
L20800HCPCS / CPT®HKAFO UNILAT TORSION CABLE
L20900HCPCS / CPT®HKAFO UNILAT TORSION BALL BR
L21060HCPCS / CPT®AFO TIB FX CAST PLASTER MOLD
L21080HCPCS / CPT®AFO TIB FX CAST MOLDED TO PT
L21120HCPCS / CPT®AFO TIBIAL FRACTURE SOFT
L21140HCPCS / CPT®AFO TIB FX SEMI-RIGID
L21160HCPCS / CPT®AFO TIBIAL FRACTURE RIGID
L21260HCPCS / CPT®KAFO FEM FX CAST THERMOPLAS
L21280HCPCS / CPT®KAFO FEM FX CAST MOLDED TO P
L21320HCPCS / CPT®KAFO FEMORAL FX CAST SOFT
L21340HCPCS / CPT®KAFO FEM FX CAST SEMI-RIGID
L21360HCPCS / CPT®KAFO FEMORAL FX CAST RIGID
L21800HCPCS / CPT®PLAS SHOE INSERT W ANK JOINT
L21820HCPCS / CPT®DROP LOCK KNEE
L21840HCPCS / CPT®LIMITED MOTION KNEE JOINT
L21860HCPCS / CPT®ADJ MOTION KNEE JNT LERMAN T
L21880HCPCS / CPT®QUADRILATERAL BRIM
L21900HCPCS / CPT®WAIST BELT
L21920HCPCS / CPT®PELVIC BAND & BELT THIGH FLA
L22000HCPCS / CPT®LIMITED ANKLE MOTION EA JNT
L22100HCPCS / CPT®DORSIFLEXION ASSIST EACH JOI
L22200HCPCS / CPT®DORSI & PLANTAR FLEX ASS/RES
L22300HCPCS / CPT®SPLIT FLAT CALIPER STIRR & P
L22320HCPCS / CPT®ROCKER BOTTOM, CONTACT AFO
L22400HCPCS / CPT®ROUND CALIPER AND PLATE ATTA
L22500HCPCS / CPT®FOOT PLATE MOLDED STIRRUP AT
L22600HCPCS / CPT®REINFORCED SOLID STIRRUP
L22650HCPCS / CPT®LONG TONGUE STIRRUP
L22700HCPCS / CPT®VARUS/VALGUS STRAP PADDED/LI
L22750HCPCS / CPT®PLASTIC MOD LOW EXT PAD/LINE
L22800HCPCS / CPT®MOLDED INNER BOOT
L23000HCPCS / CPT®ABDUCTION BAR JOINTED ADJUST
L23100HCPCS / CPT®ABDUCTION BAR-STRAIGHT
L23200HCPCS / CPT®NON-MOLDED LACER
L23300HCPCS / CPT®LACER MOLDED TO PATIENT MODE
L23350HCPCS / CPT®ANTERIOR SWING BAND
L23400HCPCS / CPT®PRE-TIBIAL SHELL MOLDED TO P
L23500HCPCS / CPT®PROSTHETIC TYPE SOCKET MOLDE
L23600HCPCS / CPT®EXTENDED STEEL SHANK
L23700HCPCS / CPT®PATTEN BOTTOM
L23750HCPCS / CPT®TORSION ANK & HALF SOLID STI
L23800HCPCS / CPT®TORSION STRAIGHT KNEE JOINT
L23850HCPCS / CPT®STRAIGHT KNEE JOINT HEAVY DU
L23870HCPCS / CPT®ADD LE POLY KNEE CUSTOM KAFO
L23900HCPCS / CPT®OFFSET KNEE JOINT EACH
L23950HCPCS / CPT®OFFSET KNEE JOINT HEAVY DUTY
L23970HCPCS / CPT®SUSPENSION SLEEVE LOWER EXT
L24050HCPCS / CPT®KNEE JOINT DROP LOCK EA JNT
L24150HCPCS / CPT®KNEE JOINT CAM LOCK EACH JOI
L24250HCPCS / CPT®KNEE DISC/DIAL LOCK/ADJ FLEX
L24300HCPCS / CPT®KNEE JNT RATCHET LOCK EA JNT
L24920HCPCS / CPT®KNEE LIFT LOOP DROP LOCK RIN
L25000HCPCS / CPT®THI/GLUT/ISCHIA WGT BEARING
L25100HCPCS / CPT®TH/WGHT BEAR QUAD-LAT BRIM M
L25200HCPCS / CPT®TH/WGHT BEAR QUAD-LAT BRIM C
L25250HCPCS / CPT®TH/WGHT BEAR NAR M-L BRIM MO
L25260HCPCS / CPT®TH/WGHT BEAR NAR M-L BRIM CU
L25300HCPCS / CPT®THIGH/WGHT BEAR LACER NON-MO
L25400HCPCS / CPT®THIGH/WGHT BEAR LACER MOLDED
L25500HCPCS / CPT®THIGH/WGHT BEAR HIGH ROLL CU
L25700HCPCS / CPT®HIP CLEVIS TYPE 2 POSIT JNT
L25800HCPCS / CPT®PELVIC CONTROL PELVIC SLING
L26000HCPCS / CPT®HIP CLEVIS/THRUST BEARING FR
L26100HCPCS / CPT®HIP CLEVIS/THRUST BEARING LO
L26200HCPCS / CPT®PELVIC CONTROL HIP HEAVY DUT
L26220HCPCS / CPT®HIP JOINT ADJUSTABLE FLEXION
L26240HCPCS / CPT®HIP ADJ FLEX EXT ABDUCT CONT
L26270HCPCS / CPT®PLASTIC MOLD RECIPRO HIP & C
L26280HCPCS / CPT®METAL FRAME RECIPRO HIP & CA
L26300HCPCS / CPT®PELVIC CONTROL BAND & BELT U
L26400HCPCS / CPT®PELVIC CONTROL BAND & BELT B
L26500HCPCS / CPT®PELV & THOR CONTROL GLUTEAL
L26600HCPCS / CPT®THORACIC CONTROL THORACIC BA
L26700HCPCS / CPT®THORAC CONT PARASPINAL UPRIG
L26800HCPCS / CPT®THORAC CONT LAT SUPPORT UPRI
L27500HCPCS / CPT®PLATING CHROME/NICKEL PR BAR
L27550HCPCS / CPT®CARBON GRAPHITE LAMINATION
L27600HCPCS / CPT®EXTENSION PER EXTENSION PER
L27680HCPCS / CPT®ORTHO SIDEBAR DISCONNECT
L27800HCPCS / CPT®NON-CORROSIVE FINISH
L27850HCPCS / CPT®DROP LOCK RETAINER EACH
L27950HCPCS / CPT®KNEE CONTROL FULL KNEECAP
L28000HCPCS / CPT®KNEE CAP MEDIAL OR LATERAL P
L28100HCPCS / CPT®KNEE CONTROL CONDYLAR PAD
L28200HCPCS / CPT®SOFT INTERFACE BELOW KNEE SE
L28300HCPCS / CPT®SOFT INTERFACE ABOVE KNEE SE
L28400HCPCS / CPT®TIBIAL LENGTH SOCK FX OR EQU
L28500HCPCS / CPT®FEMORAL LGTH SOCK FX OR EQUA
L28610HCPCS / CPT®TORSION MECHANISM KNEE/ANKLE
L29990HCPCS / CPT®LOWER EXTREMITY ORTHOSIS NOS
L30000HCPCS / CPT®FT INSERT UCB BERKELEY SHELL
L30010HCPCS / CPT®FOOT INSERT REMOV MOLDED SPE
L30020HCPCS / CPT®FOOT INSERT PLASTAZOTE OR EQ
L30030HCPCS / CPT®FOOT INSERT SILICONE GEL EAC
L30100HCPCS / CPT®FOOT LONGITUDINAL ARCH SUPPO
L30200HCPCS / CPT®FOOT LONGITUD/METATARSAL SUP
L30300HCPCS / CPT®FOOT ARCH SUPPORT REMOV PREM
L30310HCPCS / CPT®FOOT LAMIN/PREPREG COMPOSITE
L30400HCPCS / CPT®FT ARCH SUPRT PREMOLD LONGIT
L30500HCPCS / CPT®FOOT ARCH SUPP PREMOLD METAT
L30600HCPCS / CPT®FOOT ARCH SUPP LONGITUD/META
L30700HCPCS / CPT®ARCH SUPRT ATT TO SHO LONGIT
L30800HCPCS / CPT®ARCH SUPP ATT TO SHOE METATA
L30900HCPCS / CPT®ARCH SUPP ATT TO SHOE LONG/M
L31000HCPCS / CPT®HALLUS-VALGUS NT DYN PRE OTS
L31400HCPCS / CPT®ABDUCTION ROTATION BAR SHOE
L31500HCPCS / CPT®ABDUCT ROTATION BAR W/O SHOE
L31600HCPCS / CPT®SHOE STYLED POSITIONING DEV
L31700HCPCS / CPT®FOOT PLAS HEEL STABI PRE OTS
L32010HCPCS / CPT®OXFORD W SUPINAT/PRONAT INF
L32020HCPCS / CPT®OXFORD W/ SUPINAT/PRONATOR C
L32030HCPCS / CPT®OXFORD W/ SUPINATOR/PRONATOR
L32040HCPCS / CPT®HIGHTOP W/ SUPP/PRONATOR INF
L32060HCPCS / CPT®HIGHTOP W/ SUPP/PRONATOR CHI
L32070HCPCS / CPT®HIGHTOP W/ SUPP/PRONATOR JUN
L32080HCPCS / CPT®SURGICAL BOOT EACH INFANT
L32090HCPCS / CPT®SURGICAL BOOT EACH CHILD
L32110HCPCS / CPT®SURGICAL BOOT EACH JUNIOR
L32120HCPCS / CPT®BENESCH BOOT PAIR INFANT
L32130HCPCS / CPT®BENESCH BOOT PAIR CHILD
L32140HCPCS / CPT®BENESCH BOOT PAIR JUNIOR
L32150HCPCS / CPT®ORTHOPEDIC FTWEAR LADIES OXF
L32160HCPCS / CPT®ORTHOPED LADIES SHOES DPTH I
L32170HCPCS / CPT®LADIES SHOES HIGHTOP DEPTH I
L32190HCPCS / CPT®ORTHOPEDIC MENS SHOES OXFORD
L32210HCPCS / CPT®ORTHOPEDIC MENS SHOES DPTH I
L32220HCPCS / CPT®MENS SHOES HIGHTOP DEPTH INL
L32240HCPCS / CPT®WOMAN’S SHOE OXFORD BRACE
L32250HCPCS / CPT®MAN’S SHOE OXFORD BRACE
L32300HCPCS / CPT®CUSTOM SHOES DEPTH INLAY
L32500HCPCS / CPT®CUSTOM MOLD SHOE REMOV PROST
L32510HCPCS / CPT®SHOE MOLDED TO PT SILICONE S
L32520HCPCS / CPT®SHOE MOLDED PLASTAZOTE CUST
L32530HCPCS / CPT®SHOE MOLDED PLASTAZOTE CUST
L32540HCPCS / CPT®ORTH FOOT NON-STNDARD SIZE/W
L32550HCPCS / CPT®ORTH FOOT NON-STANDARD SIZE/
L32570HCPCS / CPT®ORTH FOOT ADD CHARGE SPLIT S
L326079HCPCS / CPT®AMBULATORY SURGICAL BOOT EAC
L32650HCPCS / CPT®PLASTAZOTE SANDAL EACH
L33000HCPCS / CPT®SHO LIFT TAPER TO METATARSAL
L33100HCPCS / CPT®SHOE LIFT ELEV HEEL/SOLE NEO
L33200HCPCS / CPT®SHOE LIFT ELEV HEEL/SOLE COR
L33300HCPCS / CPT®LIFTS ELEVATION METAL EXTENS
L33320HCPCS / CPT®SHOE LIFTS TAPERED TO ONE-HA
L33340HCPCS / CPT®SHOE LIFTS ELEVATION HEEL /I
L33400HCPCS / CPT®SHOE WEDGE SACH
L33500HCPCS / CPT®SHOE HEEL WEDGE
L33600HCPCS / CPT®SHOE SOLE WEDGE OUTSIDE SOLE
L33700HCPCS / CPT®SHOE SOLE WEDGE BETWEEN SOLE
L33800HCPCS / CPT®SHOE CLUBFOOT WEDGE
L33900HCPCS / CPT®SHOE OUTFLARE WEDGE
L34000HCPCS / CPT®SHOE METATARSAL BAR WEDGE RO
L34100HCPCS / CPT®SHOE METATARSAL BAR BETWEEN
L34200HCPCS / CPT®FULL SOLE/HEEL WEDGE BTWEEN
L34300HCPCS / CPT®SHO HEEL COUNT PLAST REINFOR
L34400HCPCS / CPT®HEEL LEATHER REINFORCED
L34500HCPCS / CPT®SHOE HEEL SACH CUSHION TYPE
L34550HCPCS / CPT®SHOE HEEL NEW LEATHER STANDA
L34600HCPCS / CPT®SHOE HEEL NEW RUBBER STANDAR
L34650HCPCS / CPT®SHOE HEEL THOMAS WITH WEDGE
L34700HCPCS / CPT®SHOE HEEL THOMAS EXTEND TO B
L34800HCPCS / CPT®SHOE HEEL PAD & DEPRESS FOR
L34850HCPCS / CPT®SHOE HEEL PAD REMOVABLE FOR
L35000HCPCS / CPT®ORTHO SHOE ADD LEATHER INSOL
L35100HCPCS / CPT®ORTHOPEDIC SHOE ADD RUB INSL
L35200HCPCS / CPT®O SHOE ADD FELT W LEATH INSL
L35300HCPCS / CPT®ORTHO SHOE ADD HALF SOLE
L35400HCPCS / CPT®ORTHO SHOE ADD FULL SOLE
L35500HCPCS / CPT®O SHOE ADD STANDARD TOE TAP
L35600HCPCS / CPT®O SHOE ADD HORSESHOE TOE TAP
L35700HCPCS / CPT®O SHOE ADD INSTEP EXTENSION
L35800HCPCS / CPT®O SHOE ADD INSTEP VELCRO CLO
L35900HCPCS / CPT®O SHOE CONVERT TO SOF COUNTE
L35950HCPCS / CPT®ORTHO SHOE ADD MARCH BAR
L36000HCPCS / CPT®TRANS SHOE CALIP PLATE EXIST
L36100HCPCS / CPT®TRANS SHOE CALIPER PLATE NEW
L36200HCPCS / CPT®TRANS SHOE SOLID STIRRUP EXI
L36300HCPCS / CPT®TRANS SHOE SOLID STIRRUP NEW
L36400HCPCS / CPT®SHOE DENNIS BROWNE SPLINT BO
L36490HCPCS / CPT®ORTHOPEDIC SHOE MODIFICA NOS
L36500HCPCS / CPT®SO 8 ABD RESTRAINT PRE OTS
L36600HCPCS / CPT®SO 8 AB RSTR CAN/WEB PRE OTS
L36700HCPCS / CPT®SO ACRO/CLAV CAN WEB PRE OTS
L36710HCPCS / CPT®SO CAP DESIGN W/O JNTS CF
L36740HCPCS / CPT®SO AIRPLANE W/WO JOINT CF
L36750HCPCS / CPT®SO VEST CANVAS/WEB PRE OTS
L36770HCPCS / CPT®SO HARD PLAS STABILI PRE CST
L36780HCPCS / CPT®SO HARD PLAS STABILI PRE OTS
L37020HCPCS / CPT®EO W/O JOINTS CF
L37100HCPCS / CPT®EO ELAS W/METAL JNTS PRE OTS
L37200HCPCS / CPT®FOREARM/ARM CUFFS FREE MOTIO
L37300HCPCS / CPT®FOREARM/ARM CUFFS EXT/FLEX A
L37400HCPCS / CPT®CUFFS ADJ LOCK W/ ACTIVE CON
L37600HCPCS / CPT®EO WITHJOINT, PREFABRICATED
L37620HCPCS / CPT®EO RIGID W/O JOINTS PRE OTS
L37630HCPCS / CPT®EWHO RIGID W/O JNTS CF
L37640HCPCS / CPT®EWHO W/JOINT(S) CF
L37650HCPCS / CPT®EWHFO RIGID W/O JNTS CF
L37660HCPCS / CPT®EWHFO W/JOINT(S) CF
L38060HCPCS / CPT®WHFO W/JOINT(S) CUSTOM FAB
L38070HCPCS / CPT®WHFO W/O JOINTS PRE CST
L38080HCPCS / CPT®WHFO, RIGID W/O JOINTS
L38090HCPCS / CPT®WHFO W/O JOINTS PRE OTS
L38910HCPCS / CPT®TORSION MECHANISM WRIST/ELBO
L39000HCPCS / CPT®HINGE EXTENSION/FLEX WRIST/F
L39010HCPCS / CPT®HINGE EXT/FLEX WRIST FINGER
L39040HCPCS / CPT®WHFO ELECTRIC CUSTOM FITTED
L39050HCPCS / CPT®WHO W/NONTORSION JNT(S) CF
L39060HCPCS / CPT®WHO W/O JOINTS CF
L390879HCPCS / CPT®WHO COCK-UP NONMOLDE PRE OTS
L39120HCPCS / CPT®HFO FLEXION GLOVE PRE OTS
L39130HCPCS / CPT®HFO W/O JOINTS CF
L39150HCPCS / CPT®WHO NONTORSION JNTS PRE CST
L39160HCPCS / CPT®WHO NONTORSION JNTS PRE OTS
L39170HCPCS / CPT®METACARP FX ORTHOSIS PRE CST
L39180HCPCS / CPT®METACARP FX ORTHOSIS PRE OTS
L39190HCPCS / CPT®HO W/O JOINTS CF
L39210HCPCS / CPT®HFO W/JOINT(S) CF
L39230HCPCS / CPT®HFO WITHOUT JOINTS PRE CST
L39240HCPCS / CPT®HFO WITHOUT JOINTS PRE OTS
L39250HCPCS / CPT®FO PIP DIP JNT/SPRNG PRE OTS
L39270HCPCS / CPT®FO PIP DIP NO JT SPR PRE OTS
L39290HCPCS / CPT®HFO NONTORSION JNTS PRE CST
L39300HCPCS / CPT®HFO NONTORSION JNTS PRE OTS
L39310HCPCS / CPT®WHFO NONTORSION JOINT PREFAB
L39330HCPCS / CPT®FO W/O JOINTS CF
L39350HCPCS / CPT®FO NONTORSION JOINT CF
L39560HCPCS / CPT®ADD JOINT UPPER EXT ORTHOSIS
L39600HCPCS / CPT®SEWHO AIRPLAN DESIG ABDU POS
L39610HCPCS / CPT®SEWHO CAP DESIGN W/O JNTS CF
L39620HCPCS / CPT®SEWHO ERBS PALSEY DESIGN ABD
L39670HCPCS / CPT®SEWHO AIRPLANE W/O JNTS CF
L39710HCPCS / CPT®SEWHO CAP DESIGN W/JNT(S) CF
L39730HCPCS / CPT®SEWHO AIRPLANE W/JNT(S) CF
L39750HCPCS / CPT®SEWHFO CAP DESIGN W/O JNT CF
L39760HCPCS / CPT®SEWHFO AIRPLANE W/O JNTS CF
L39770HCPCS / CPT®SEWHFO CAP DESGN W/JNT(S) CF
L39780HCPCS / CPT®SEWHFO AIRPLANE W/JNT(S) CF
L39800HCPCS / CPT®UP EXT FX ORTHOS HUMERAL NOS
L39810HCPCS / CPT®UE FX ORTH SHOUL CAP FOREARM
L39820HCPCS / CPT®UPPER EXT FX ORTHOSIS RAD/UL
L39840HCPCS / CPT®UPPER EXT FX ORTHOSIS WRIST
L39950HCPCS / CPT®SOCK FRACTURE OR EQUAL EACH
L39990HCPCS / CPT®UPPER LIMB ORTHOSIS NOS
L40000HCPCS / CPT®REPL GIRDLE MILWAUKEE ORTH
L40020HCPCS / CPT®REPLACE STRAP, ANY ORTHOSIS
L40100HCPCS / CPT®REPLACE TRILATERAL SOCKET BR
L40200HCPCS / CPT®REPLACE QUADLAT SOCKET BRIM
L40300HCPCS / CPT®REPLACE SOCKET BRIM CUST FIT
L40400HCPCS / CPT®REPLACE MOLDED THIGH LACER
L40450HCPCS / CPT®REPLACE NON-MOLDED THIGH LAC
L40500HCPCS / CPT®REPLACE MOLDED CALF LACER
L40550HCPCS / CPT®REPLACE NON-MOLDED CALF LACE
L40600HCPCS / CPT®REPLACE HIGH ROLL CUFF
L40700HCPCS / CPT®REPLACE PROX & DIST UPRIGHT
L40800HCPCS / CPT®REPL MET BAND KAFO-AFO PROX
L40900HCPCS / CPT®REPL MET BAND KAFO-AFO CALF/
L41000HCPCS / CPT®REPL LEATH CUFF KAFO PROX TH
L41100HCPCS / CPT®REPL LEATH CUFF KAFO-AFO CAL
L41300HCPCS / CPT®REPLACE PRETIBIAL SHELL
L42050HCPCS / CPT®ORTHO DVC REPAIR PER 15 MIN
L42100HCPCS / CPT®ORTH DEV REPAIR/REPL MINOR P
L4350412HCPCS / CPT®ANKLE CONTROL ORTHO PRE OTS
L4360106HCPCS / CPT®PNEUMAT WALKING BOOT PRE CST
L43610HCPCS / CPT®PNEUMA/VAC WALK BOOT PRE OTS
L43700HCPCS / CPT®PNEUM FULL LEG SPLNT PRE OTS
L4380114HCPCS / CPT®PNEUMATIC KNEE SPLINT
L4386153HCPCS / CPT®NON-PNEUM WALK BOOT PRE CST
L43870HCPCS / CPT®NON-PNEUM WALK BOOT PRE OTS
L43920HCPCS / CPT®REPLACE AFO SOFT INTERFACE
L43940HCPCS / CPT®REPLACE FOOT DROP SPINT
L43960HCPCS / CPT®STATIC OR DYNAMI AFO PRE CST
L43970HCPCS / CPT®STATIC OR DYNAMI AFO PRE OTS
L43980HCPCS / CPT®FOOT DROP SPLINT PRE OTS
L46310HCPCS / CPT®AFO, WALK BOOT TYPE, CUS FAB
L50000HCPCS / CPT®SHO INSERT W ARCH TOE FILLER
L50100HCPCS / CPT®MOLD SOCKET ANK HGT W/ TOE F
L50200HCPCS / CPT®TIBIAL TUBERCLE HGT W/ TOE F
L50500HCPCS / CPT®ANK SYMES MOLD SCKT SACH FT
L50600HCPCS / CPT®SYMES MET FR LEATH SOCKET AR
L51000HCPCS / CPT®MOLDED SOCKET SHIN SACH FOOT
L51050HCPCS / CPT®PLAST SOCKET JTS/THGH LACER
L51500HCPCS / CPT®MOLD SCKT EXT KNEE SHIN SACH
L51600HCPCS / CPT®MOLD SOCKET BENT KNEE SHIN S
L52000HCPCS / CPT®KNE SING AXIS FRIC SHIN SACH
L52100HCPCS / CPT®NO KNEE/ANKLE JOINTS W/ FT B
L52200HCPCS / CPT®NO KNEE JOINT WITH ARTIC ALI
L52300HCPCS / CPT®FEM FOCAL DEFIC CONSTANT FRI
L52500HCPCS / CPT®HIP CANAD SING AXI CONS FRIC
L52700HCPCS / CPT®TILT TABLE LOCKING HIP SING
L52800HCPCS / CPT®HEMIPELVECT CANAD SING AXIS
L53010HCPCS / CPT®BK MOLD SOCKET SACH FT ENDO
L53120HCPCS / CPT®KNEE DISART, SACH FT, ENDO
L53210HCPCS / CPT®AK OPEN END SACH
L53310HCPCS / CPT®HIP DISART CANADIAN SACH FT
L53410HCPCS / CPT®HEMIPELVECTOMY CANADIAN SACH
L54000HCPCS / CPT®POSTOP DRESS & 1 CAST CHG BK
L54100HCPCS / CPT®POSTOP DSG BK EA ADD CAST CH
L54200HCPCS / CPT®POSTOP DSG & 1 CAST CHG AK/D
L54300HCPCS / CPT®POSTOP DSG AK EA ADD CAST CH
L54500HCPCS / CPT®POSTOP APP NON-WGT BEAR DSG
L54600HCPCS / CPT®POSTOP APP NON-WGT BEAR DSG
L55000HCPCS / CPT®INIT BK PTB PLASTER DIRECT
L55050HCPCS / CPT®INIT AK ISCHAL PLSTR DIRECT
L55100HCPCS / CPT®PREP BK PTB PLASTER MOLDED
L55200HCPCS / CPT®PERP BK PTB THERMOPLS DIRECT
L55300HCPCS / CPT®PREP BK PTB THERMOPLS MOLDED
L55350HCPCS / CPT®PREP BK PTB OPEN END SOCKET
L55400HCPCS / CPT®PREP BK PTB LAMINATED SOCKET
L55600HCPCS / CPT®PREP AK ISCHIAL PLAST MOLDED
L55700HCPCS / CPT®PREP AK ISCHIAL DIRECT FORM
L55800HCPCS / CPT®PREP AK ISCHIAL THERMO MOLD
L55850HCPCS / CPT®PREP AK ISCHIAL OPEN END
L55900HCPCS / CPT®PREP AK ISCHIAL LAMINATED
L55950HCPCS / CPT®HIP DISARTIC SACH THERMOPLS
L56000HCPCS / CPT®HIP DISART SACH LAMINAT MOLD
L56100HCPCS / CPT®ABOVE KNEE HYDRACADENCE
L56110HCPCS / CPT®AK 4 BAR LINK W/FRIC SWING
L56130HCPCS / CPT®AK 4 BAR LING W/HYDRAUL SWIG
L56140HCPCS / CPT®4-BAR LINK ABOVE KNEE W/SWNG
L56160HCPCS / CPT®AK UNIV MULTIPLEX SYS FRICT
L56170HCPCS / CPT®AK/BK SELF-ALIGNING UNIT EA
L56180HCPCS / CPT®TEST SOCKET SYMES
L56200HCPCS / CPT®TEST SOCKET BELOW KNEE
L56220HCPCS / CPT®TEST SOCKET KNEE DISARTICULA
L56240HCPCS / CPT®TEST SOCKET ABOVE KNEE
L56260HCPCS / CPT®TEST SOCKET HIP DISARTICULAT
L56280HCPCS / CPT®TEST SOCKET HEMIPELVECTOMY
L56290HCPCS / CPT®BELOW KNEE ACRYLIC SOCKET
L56300HCPCS / CPT®SYME TYP EXPANDABL WALL SCKT
L56310HCPCS / CPT®AK/KNEE DISARTIC ACRYLIC SOC
L56320HCPCS / CPT®SYMES TYPE PTB BRIM DESIGN S
L56340HCPCS / CPT®SYMES TYPE POSTER OPENING SO
L56360HCPCS / CPT®SYMES TYPE MEDIAL OPENING SO
L56370HCPCS / CPT®BELOW KNEE TOTAL CONTACT
L56380HCPCS / CPT®BELOW KNEE LEATHER SOCKET
L56390HCPCS / CPT®BELOW KNEE WOOD SOCKET
L56400HCPCS / CPT®KNEE DISARTICULAT LEATHER SO
L56420HCPCS / CPT®ABOVE KNEE LEATHER SOCKET
L56430HCPCS / CPT®HIP FLEX INNER SOCKET EXT FR
L56440HCPCS / CPT®ABOVE KNEE WOOD SOCKET
L56450HCPCS / CPT®BK FLEX INNER SOCKET EXT FRA
L56460HCPCS / CPT®BELOW KNEE CUSHION SOCKET
L56470HCPCS / CPT®BELOW KNEE SUCTION SOCKET
L56480HCPCS / CPT®ABOVE KNEE CUSHION SOCKET
L56490HCPCS / CPT®ISCH CONTAINMT/NARROW M-L SO
L56500HCPCS / CPT®TOT CONTACT AK/KNEE DISART S
L56510HCPCS / CPT®AK FLEX INNER SOCKET EXT FRA
L56520HCPCS / CPT®SUCTION SUSP AK/KNEE DISART
L56530HCPCS / CPT®KNEE DISART EXPAND WALL SOCK
L56540HCPCS / CPT®SOCKET INSERT SYMES
L56550HCPCS / CPT®SOCKET INSERT BELOW KNEE
L56560HCPCS / CPT®SOCKET INSERT KNEE ARTICULAT
L56580HCPCS / CPT®SOCKET INSERT ABOVE KNEE
L56610HCPCS / CPT®MULTI-DUROMETER SYMES
L56650HCPCS / CPT®MULTI-DUROMETER BELOW KNEE
L56660HCPCS / CPT®BELOW KNEE CUFF SUSPENSION
L56680HCPCS / CPT®BK MOLDED DISTAL CUSHION
L56700HCPCS / CPT®BK MOLDED SUPRACONDYLAR SUSP
L56710HCPCS / CPT®BK/AK LOCKING MECHANISM
L56720HCPCS / CPT®BK REMOVABLE MEDIAL BRIM SUS
L56730HCPCS / CPT®SOCKET INSERT W LOCK MECH
L56760HCPCS / CPT®BK KNEE JOINTS SINGLE AXIS P
L56770HCPCS / CPT®BK KNEE JOINTS POLYCENTRIC P
L56780HCPCS / CPT®BK JOINT COVERS PAIR
L56790HCPCS / CPT®SOCKET INSERT W/O LOCK MECH
L56800HCPCS / CPT®BK THIGH LACER NON-MOLDED
L56810HCPCS / CPT®INTL CUSTM CONG/LATYP INSERT
L56820HCPCS / CPT®BK THIGH LACER GLUT/ISCHIA M
L56830HCPCS / CPT®INITIAL CUSTOM SOCKET INSERT
L56840HCPCS / CPT®BK FORK STRAP
L56850HCPCS / CPT®BELOW KNEE SUS/SEAL SLEEVE
L56860HCPCS / CPT®BK BACK CHECK
L56880HCPCS / CPT®BK WAIST BELT WEBBING
L56900HCPCS / CPT®BK WAIST BELT PADDED AND LIN
L56920HCPCS / CPT®AK PELVIC CONTROL BELT LIGHT
L56940HCPCS / CPT®AK PELVIC CONTROL BELT PAD/L
L56950HCPCS / CPT®AK SLEEVE SUSP NEOPRENE/EQUA
L56960HCPCS / CPT®AK/KNEE DISARTIC PELVIC JOIN
L56970HCPCS / CPT®AK/KNEE DISARTIC PELVIC BAND
L56980HCPCS / CPT®AK/KNEE DISARTIC SILESIAN BA
L56990HCPCS / CPT®SHOULDER HARNESS
L57000HCPCS / CPT®REPLACE SOCKET BELOW KNEE
L57010HCPCS / CPT®REPLACE SOCKET ABOVE KNEE
L57020HCPCS / CPT®REPLACE SOCKET HIP
L57030HCPCS / CPT®SYMES ANKLE W/O (SACH) FOOT
L57040HCPCS / CPT®CUSTOM SHAPE COVER BK
L57050HCPCS / CPT®CUSTOM SHAPE COVER AK
L57060HCPCS / CPT®CUSTOM SHAPE CVR KNEE DISART
L57070HCPCS / CPT®CUSTOM SHAPE CVR HIP DISART
L57100HCPCS / CPT®KNE-SHIN EXO SNG AXI MNL LOC
L57110HCPCS / CPT®KNEE-SHIN EXO MNL LOCK ULTRA
L57120HCPCS / CPT®KNEE-SHIN EXO FRICT SWG & ST
L57140HCPCS / CPT®KNEE-SHIN EXO VARIABLE FRICT
L57160HCPCS / CPT®KNEE-SHIN EXO MECH STANCE PH
L57180HCPCS / CPT®KNEE-SHIN EXO FRCT SWG & STA
L57220HCPCS / CPT®KNEE-SHIN PNEUM SWG FRCT EXO
L57240HCPCS / CPT®KNEE-SHIN EXO FLUID SWING PH
L57260HCPCS / CPT®KNEE-SHIN EXT JNTS FLD SWG E
L57280HCPCS / CPT®KNEE-SHIN FLUID SWG & STANCE
L57800HCPCS / CPT®KNEE-SHIN PNEUM/HYDRA PNEUM
L57810HCPCS / CPT®LOWER LIMB PROS VACUUM PUMP
L57820HCPCS / CPT®HD LOW LIMB PROS VACUUM PUMP
L57850HCPCS / CPT®EXOSKELETAL BK ULTRALT MATER
L57900HCPCS / CPT®EXOSKELETAL AK ULTRA-LIGHT M
L57950HCPCS / CPT®EXOSKEL HIP ULTRA-LIGHT MATE
L58100HCPCS / CPT®ENDOSKEL KNEE-SHIN MNL LOCK
L58110HCPCS / CPT®ENDO KNEE-SHIN MNL LCK ULTRA
L58120HCPCS / CPT®ENDO KNEE-SHIN FRCT SWG & ST
L58140HCPCS / CPT®ENDO KNEE-SHIN HYDRAL SWG PH
L58160HCPCS / CPT®ENDO KNEE-SHIN POLYC MCH STA
L58180HCPCS / CPT®ENDO KNEE-SHIN FRCT SWG & ST
L58220HCPCS / CPT®ENDO KNEE-SHIN PNEUM SWG FRC
L58240HCPCS / CPT®ENDO KNEE-SHIN FLUID SWING P
L58260HCPCS / CPT®MINIATURE KNEE JOINT
L58280HCPCS / CPT®ENDO KNEE-SHIN FLUID SWG/STA
L58300HCPCS / CPT®ENDO KNEE-SHIN PNEUM/SWG PHA
L58400HCPCS / CPT®MULTI-AXIAL KNEE/SHIN SYSTEM
L58450HCPCS / CPT®KNEE-SHIN SYS STANCE FLEXION
L58480HCPCS / CPT®KNEE-SHIN SYS HYDRAUL STANCE
L58500HCPCS / CPT®ENDO AK/HIP KNEE EXTENS ASSI
L58550HCPCS / CPT®MECH HIP EXTENSION ASSIST
L58560HCPCS / CPT®ELEC KNEE-SHIN SWING/STANCE
L58570HCPCS / CPT®ELEC KNEE-SHIN SWING ONLY
L58580HCPCS / CPT®STANCE PHASE ONLY
L58590HCPCS / CPT®KNEE-SHIN PRO FLEX/EXT CONT
L59100HCPCS / CPT®ENDO BELOW KNEE ALIGNABLE SY
L59200HCPCS / CPT®ENDO AK/HIP ALIGNABLE SYSTEM
L59250HCPCS / CPT®ABOVE KNEE MANUAL LOCK
L59300HCPCS / CPT®HIGH ACTIVITY KNEE FRAME
L59400HCPCS / CPT®ENDO BK ULTRA-LIGHT MATERIAL
L59500HCPCS / CPT®ENDO AK ULTRA-LIGHT MATERIAL
L59600HCPCS / CPT®ENDO HIP ULTRA-LIGHT MATERIA
L59610HCPCS / CPT®ENDO POLY HIP, PNEU/HYD/ROT
L59620HCPCS / CPT®BELOW KNEE FLEX COVER SYSTEM
L59640HCPCS / CPT®ABOVE KNEE FLEX COVER SYSTEM
L59660HCPCS / CPT®HIP FLEXIBLE COVER SYSTEM
L59680HCPCS / CPT®MULTIAXIAL ANKLE W DORSIFLEX
L59690HCPCS / CPT®AK/FT POWER ASST INCL MOTORS
L59700HCPCS / CPT®FOOT EXTERNAL KEEL SACH FOOT
L59710HCPCS / CPT®SACH FOOT, REPLACEMENT
L59720HCPCS / CPT®FLEXIBLE KEEL FOOT
L59730HCPCS / CPT®ANK-FOOT SYS DORS-PLANT FLEX
L59740HCPCS / CPT®FOOT SINGLE AXIS ANKLE/FOOT
L59750HCPCS / CPT®COMBO ANKLE/FOOT PROSTHESIS
L59760HCPCS / CPT®ENERGY STORING FOOT
L59780HCPCS / CPT®FT PROSTH MULTIAXIAL ANKL/FT
L59790HCPCS / CPT®MULTI-AXIAL ANKLE/FT PROSTH
L59800HCPCS / CPT®FLEX FOOT SYSTEM
L59810HCPCS / CPT®FLEX-WALK SYS LOW EXT PROSTH
L59820HCPCS / CPT®EXOSKELETAL AXIAL ROTATION U
L59840HCPCS / CPT®ENDOSKELETAL AXIAL ROTATION
L59850HCPCS / CPT®LWR EXT DYNAMIC PROSTH PYLON
L59860HCPCS / CPT®MULTI-AXIAL ROTATION UNIT
L59870HCPCS / CPT®SHANK FT W VERT LOAD PYLON
L59880HCPCS / CPT®VERTICAL SHOCK REDUCING PYLO
L59900HCPCS / CPT®USER ADJUSTABLE HEEL HEIGHT
L59990HCPCS / CPT®LOWR EXTREMITY PROSTHES NOS
L60000HCPCS / CPT®PART HAND THUMB REM
L60100HCPCS / CPT®PART HAND LITTLE/RING
L60200HCPCS / CPT®PART HAND NO FINGERS
L60260HCPCS / CPT®PART HAND MYO EXCLU TERM DEV
L60500HCPCS / CPT®WRST MLD SCK FLX HNG TRI PAD
L60550HCPCS / CPT®WRST MOLD SOCK W/EXP INTERFA
L61000HCPCS / CPT®ELB MOLD SOCK FLEX HINGE PAD
L61100HCPCS / CPT®ELBOW MOLD SOCK SUSPENSION T
L61200HCPCS / CPT®ELBOW MOLD DOUB SPLT SOC STE
L61300HCPCS / CPT®ELBOW STUMP ACTIVATED LOCK H
L62000HCPCS / CPT®ELBOW MOLD OUTSID LOCK HINGE
L62050HCPCS / CPT®ELBOW MOLDED W/ EXPAND INTER
L62500HCPCS / CPT®ELBOW INTER LOC ELBOW FORARM
L63000HCPCS / CPT®SHLDER DISART INT LOCK ELBOW
L63100HCPCS / CPT®SHOULDER PASSIVE RESTOR COMP
L63200HCPCS / CPT®SHOULDER PASSIVE RESTOR CAP
L63500HCPCS / CPT®THORACIC INTERN LOCK ELBOW
L63600HCPCS / CPT®THORACIC PASSIVE RESTOR COMP
L63700HCPCS / CPT®THORACIC PASSIVE RESTOR CAP
L63800HCPCS / CPT®POSTOP DSG CAST CHG WRST/ELB
L63820HCPCS / CPT®POSTOP DSG CAST CHG ELB DIS/
L63840HCPCS / CPT®POSTOP DSG CAST CHG SHLDER/T
L63860HCPCS / CPT®POSTOP EA CAST CHG & REALIGN
L63880HCPCS / CPT®POSTOP APPLICAT RIGID DSG ON
L64000HCPCS / CPT®BELOW ELBOW PROSTH TISS SHAP
L64500HCPCS / CPT®ELB DISART PROSTH TISS SHAP
L65000HCPCS / CPT®ABOVE ELBOW PROSTH TISS SHAP
L65500HCPCS / CPT®SHLDR DISAR PROSTH TISS SHAP
L65700HCPCS / CPT®SCAP THORAC PROSTH TISS SHAP
L65800HCPCS / CPT®WRIST/ELBOW BOWDEN CABLE MOL
L65820HCPCS / CPT®WRIST/ELBOW BOWDEN CBL DIR F
L65840HCPCS / CPT®ELBOW FAIR LEAD CABLE MOLDED
L65860HCPCS / CPT®ELBOW FAIR LEAD CABLE DIR FO
L65880HCPCS / CPT®SHDR FAIR LEAD CABLE MOLDED
L65900HCPCS / CPT®SHDR FAIR LEAD CABLE DIRECT
L66000HCPCS / CPT®POLYCENTRIC HINGE PAIR
L66050HCPCS / CPT®SINGLE PIVOT HINGE PAIR
L66100HCPCS / CPT®FLEXIBLE METAL HINGE PAIR
L66110HCPCS / CPT®ADDITIONAL SWITCH, EXT POWER
L66150HCPCS / CPT®DISCONNECT LOCKING WRIST UNI
L66160HCPCS / CPT®DISCONNECT INSERT LOCKING WR
L66200HCPCS / CPT®FLEXION/EXTENSION WRIST UNIT
L66210HCPCS / CPT®FLEX/EXT WRIST W/WO FRICTION
L66230HCPCS / CPT®SPRING-ASS ROT WRST W/ LATCH
L66240HCPCS / CPT®FLEX/EXT/ROTATION WRIST UNIT
L66250HCPCS / CPT®ROTATION WRST W/ CABLE LOCK
L66280HCPCS / CPT®QUICK DISCONN HOOK ADAPTER O
L66290HCPCS / CPT®LAMINATION COLLAR W/ COUPLIN
L66300HCPCS / CPT®STAINLESS STEEL ANY WRIST
L66320HCPCS / CPT®LATEX SUSPENSION SLEEVE EACH
L66350HCPCS / CPT®LIFT ASSIST FOR ELBOW
L66370HCPCS / CPT®NUDGE CONTROL ELBOW LOCK
L66380HCPCS / CPT®ELEC LOCK ON MANUAL PW ELBOW
L66400HCPCS / CPT®SHOULDER ABDUCTION JOINT PAI
L66410HCPCS / CPT®EXCURSION AMPLIFIER PULLEY T
L66420HCPCS / CPT®EXCURSION AMPLIFIER LEVER TY
L66450HCPCS / CPT®SHOULDER FLEXION-ABDUCTION J
L66460HCPCS / CPT®MULTIPO LOCKING SHOULDER JNT
L66470HCPCS / CPT®SHOULDER LOCK ACTUATOR
L66480HCPCS / CPT®EXT PWRD SHLDER LOCK/UNLOCK
L66500HCPCS / CPT®SHOULDER UNIVERSAL JOINT
L66550HCPCS / CPT®STANDARD CONTROL CABLE EXTRA
L66600HCPCS / CPT®HEAVY DUTY CONTROL CABLE
L66650HCPCS / CPT®TEFLON OR EQUAL CABLE LINING
L66700HCPCS / CPT®HOOK TO HAND CABLE ADAPTER
L66720HCPCS / CPT®HARNESS CHEST/SHLDER SADDLE
L66750HCPCS / CPT®HARNESS FIGURE OF 8 SING CON
L66760HCPCS / CPT®HARNESS FIGURE OF 8 DUAL CON
L66770HCPCS / CPT®UE TRIPLE CONTROL HARNESS
L66800HCPCS / CPT®TEST SOCK WRIST DISART/BEL E
L66820HCPCS / CPT®TEST SOCK ELBW DISART/ABOVE
L66840HCPCS / CPT®TEST SOCKET SHLDR DISART/THO
L66860HCPCS / CPT®SUCTION SOCKET
L66870HCPCS / CPT®FRAME TYP SOCKET BEL ELBOW/W
L66880HCPCS / CPT®FRAME TYP SOCK ABOVE ELB/DIS
L66890HCPCS / CPT®FRAME TYP SOCKET SHOULDER DI
L66900HCPCS / CPT®FRAME TYP SOCK INTERSCAP-THO
L66910HCPCS / CPT®REMOVABLE INSERT EACH
L66920HCPCS / CPT®SILICONE GEL INSERT OR EQUAL
L66930HCPCS / CPT®LOCKINGELBOW FOREARM CNTRBAL
L66940HCPCS / CPT®ELBOW SOCKET INS USE W/LOCK
L66950HCPCS / CPT®ELBOW SOCKET INS USE W/O LCK
L66960HCPCS / CPT®CUS ELBO SKT IN FOR CON/ATYP
L66970HCPCS / CPT®CUS ELBO SKT IN NOT CON/ATYP
L66980HCPCS / CPT®BELOW/ABOVE ELBOW LOCK MECH
L67030HCPCS / CPT®TERM DEV, PASSIVE HAND MITT
L67040HCPCS / CPT®TERM DEV, SPORT/REC/WORK ATT
L67060HCPCS / CPT®TERM DEV MECH HOOK VOL OPEN
L67070HCPCS / CPT®TERM DEV MECH HOOK VOL CLOSE
L67080HCPCS / CPT®TERM DEV MECH HAND VOL OPEN
L67090HCPCS / CPT®TERM DEV MECH HAND VOL CLOSE
L67110HCPCS / CPT®PED TERM DEV, HOOK, VOL OPEN
L67120HCPCS / CPT®PED TERM DEV, HOOK, VOL CLOS
L67130HCPCS / CPT®PED TERM DEV, HAND, VOL OPEN
L67140HCPCS / CPT®PED TERM DEV, HAND, VOL CLOS
L67150HCPCS / CPT®TERM DEVICE, MULTI ART DIGIT
L67210HCPCS / CPT®HOOK/HAND, HVY DTY, VOL OPEN
L67220HCPCS / CPT®HOOK/HAND, HVY DTY, VOL CLOS
L68050HCPCS / CPT®TERM DEV MODIFIER WRIST UNIT
L68100HCPCS / CPT®TERM DEV PRECISION PINCH DEV
L68800HCPCS / CPT®ELEC HAND IND ART DIGITS
L68810HCPCS / CPT®TERM DEV AUTO GRASP FEATURE
L68820HCPCS / CPT®MICROPROCESSOR CONTROL UPLMB
L68830HCPCS / CPT®REPLC SOCKT BELOW E/W DISA
L68840HCPCS / CPT®REPLC SOCKT ABOVE ELBOW DISA
L68850HCPCS / CPT®REPLC SOCKT SHLDR DIS/INTERC
L68900HCPCS / CPT®PREFAB GLOVE FOR TERM DEVICE
L68950HCPCS / CPT®CUSTOM GLOVE FOR TERM DEVICE
L69000HCPCS / CPT®HAND RESTORAT THUMB/1 FINGER
L69050HCPCS / CPT®HAND RESTORATION MULTIPLE FI
L69100HCPCS / CPT®HAND RESTORATION NO FINGERS
L69150HCPCS / CPT®HAND RESTORATION REPLACMNT G
L69200HCPCS / CPT®WRIST DISARTICUL SWITCH CTRL
L69250HCPCS / CPT®WRIST DISART MYOELECTRONIC C
L69300HCPCS / CPT®BELOW ELBOW SWITCH CONTROL
L69350HCPCS / CPT®BELOW ELBOW MYOELECTRONIC CT
L69400HCPCS / CPT®ELBOW DISARTICULATION SWITCH
L69450HCPCS / CPT®ELBOW DISART MYOELECTRONIC C
L69500HCPCS / CPT®ABOVE ELBOW SWITCH CONTROL
L69550HCPCS / CPT®ABOVE ELBOW MYOELECTRONIC CT
L69600HCPCS / CPT®SHLDR DISARTIC SWITCH CONTRO
L69650HCPCS / CPT®SHLDR DISARTIC MYOELECTRONIC
L69700HCPCS / CPT®INTERSCAPULAR-THOR SWITCH CT
L69750HCPCS / CPT®INTERSCAP-THOR MYOELECTRONIC
L70070HCPCS / CPT®ADULT ELECTRIC HAND
L70080HCPCS / CPT®PEDIATRIC ELECTRIC HAND
L70090HCPCS / CPT®ADULT ELECTRIC HOOK
L70400HCPCS / CPT®PREHENSILE ACTUATOR
L70450HCPCS / CPT®PEDIATRIC ELECTRIC HOOK
L71700HCPCS / CPT®ELECTRONIC ELBOW HOSMER SWIT
L71800HCPCS / CPT®ELECTRONIC ELBOW SEQUENTIAL
L71810HCPCS / CPT®ELECTRONIC ELBO SIMULTANEOUS
L71850HCPCS / CPT®ELECTRON ELBOW ADOLESCENT SW
L71860HCPCS / CPT®ELECTRON ELBOW CHILD SWITCH
L71900HCPCS / CPT®ELBOW ADOLESCENT MYOELECTRON
L71910HCPCS / CPT®ELBOW CHILD MYOELECTRONIC CT
L72590HCPCS / CPT®ELECTRONIC WRIST ROTATOR ANY
L73600HCPCS / CPT®SIX VOLT BAT OTTO BOCK/EQ EA
L73620HCPCS / CPT®BATTERY CHRGR SIX VOLT OTTO
L73640HCPCS / CPT®TWELVE VOLT BATTERY UTAH/EQU
L73660HCPCS / CPT®BATTERY CHRGR 12 VOLT UTAH/E
L73670HCPCS / CPT®REPLACEMNT LITHIUM IONBATTER
L73680HCPCS / CPT®LITHIUM ION BATTERY CHARGER
L74000HCPCS / CPT®ADD UE PROST BE/WD, ULTLITE
L74010HCPCS / CPT®ADD UE PROST A/E ULTLITE MAT
L74020HCPCS / CPT®ADD UE PROST S/D ULTLITE MAT
L74030HCPCS / CPT®ADD UE PROST B/E ACRYLIC
L74040HCPCS / CPT®ADD UE PROST A/E ACRYLIC
L74050HCPCS / CPT®ADD UE PROST S/D ACRYLIC
L74990HCPCS / CPT®UPPER EXTREMITY PROSTHES NOS
L75100HCPCS / CPT®PROSTHETIC DEVICE REPAIR REP
L75200HCPCS / CPT®REPAIR PROSTHESIS PER 15 MIN
L76000HCPCS / CPT®PROSTHETIC DONNING SLEEVE
L79000HCPCS / CPT®MALE VACUUM ERECTION SYSTEM
L79020HCPCS / CPT®TENSION RING, VAC ERECT DEV
L80000HCPCS / CPT®MASTECTOMY BRA
L80010HCPCS / CPT®BREAST PROSTHESIS BRA & FORM
L80020HCPCS / CPT®BRST PRSTH BRA & BILAT FORM
L80100HCPCS / CPT®MASTECTOMY SLEEVE
L80150HCPCS / CPT®EXT BREASTPROSTHESIS GARMENT
L80200HCPCS / CPT®MASTECTOMY FORM
L80300HCPCS / CPT®BREAST PROSTHES W/O ADHESIVE
L80310HCPCS / CPT®BREAST PROSTHESIS W ADHESIVE
L80320HCPCS / CPT®REUSABLE NIPPLE PROSTHESIS
L80350HCPCS / CPT®CUSTOM BREAST PROSTHESIS
L80390HCPCS / CPT®BREAST PROSTHESIS NOS
L80400HCPCS / CPT®NASAL PROSTHESIS
L80410HCPCS / CPT®MIDFACIAL PROSTHESIS
L80420HCPCS / CPT®ORBITAL PROSTHESIS
L80430HCPCS / CPT®UPPER FACIAL PROSTHESIS
L80440HCPCS / CPT®HEMI-FACIAL PROSTHESIS
L80450HCPCS / CPT®AURICULAR PROSTHESIS
L80460HCPCS / CPT®PARTIAL FACIAL PROSTHESIS
L80470HCPCS / CPT®NASAL SEPTAL PROSTHESIS
L80480HCPCS / CPT®UNSPEC MAXILLOFACIAL PROSTH
L80490HCPCS / CPT®REPAIR MAXILLOFACIAL PROSTH
L83000HCPCS / CPT®TRUSS SINGLE W/ STANDARD PAD
L83100HCPCS / CPT®TRUSS DOUBLE W/ STANDARD PAD
L83200HCPCS / CPT®TRUSS ADDITION TO STD PAD WA
L83300HCPCS / CPT®TRUSS ADD TO STD PAD SCROTAL
L84000HCPCS / CPT®SHEATH BELOW KNEE
L84100HCPCS / CPT®SHEATH ABOVE KNEE
L84150HCPCS / CPT®SHEATH UPPER LIMB
L84170HCPCS / CPT®PROS SHEATH/SOCK W GEL CUSHN
L84200HCPCS / CPT®PROSTHETIC SOCK MULTI PLY BK
L84300HCPCS / CPT®PROSTHETIC SOCK MULTI PLY AK
L84350HCPCS / CPT®PROS SOCK MULTI PLY UPPER LM
L84400HCPCS / CPT®SHRINKER BELOW KNEE
L84600HCPCS / CPT®SHRINKER ABOVE KNEE
L84650HCPCS / CPT®SHRINKER UPPER LIMB
L84700HCPCS / CPT®PROS SOCK SINGLE PLY BK
L84800HCPCS / CPT®PROS SOCK SINGLE PLY AK
L84850HCPCS / CPT®PROS SOCK SINGLE PLY UPPER L
L84990HCPCS / CPT®UNLISTED MISC PROSTHETIC SER
L85000HCPCS / CPT®ARTIFICIAL LARYNX
L85010HCPCS / CPT®TRACHEOSTOMY SPEAKING VALVE
L85050HCPCS / CPT®ARTIFICIAL LARYNX, ACCESSORY
L85070HCPCS / CPT®TRACH-ESOPH VOICE PROS PT IN
L85090HCPCS / CPT®TRACH-ESOPH VOICE PROS MD IN
L85100HCPCS / CPT®VOICE AMPLIFIER
L85110HCPCS / CPT®INDWELLING TRACH INSERT
L85120HCPCS / CPT®GEL CAP FOR TRACH VOICE PROS
L85130HCPCS / CPT®TRACH PROS CLEANING DEVICE
L85140HCPCS / CPT®REPL TRACH PUNCTURE DILATOR
L85150HCPCS / CPT®GEL CAP APP DEVICE FOR TRACH
L86000HCPCS / CPT®IMPLANT BREAST SILICONE/EQ
L86030HCPCS / CPT®COLLAGEN IMP URINARY 2.5 ML
L86040HCPCS / CPT®DEXTRANOMER/HYALURONIC ACID
L86050HCPCS / CPT®INJ BULKING AGENT ANAL CANAL
L86060HCPCS / CPT®SYNTHETIC IMPLNT URINARY 1ML
L86070HCPCS / CPT®INJ VOCAL CORD BULKING AGENT
L86090HCPCS / CPT®ARTIFICIAL CORNEA
L86100HCPCS / CPT®OCULAR IMPLANT
L86120HCPCS / CPT®AQUEOUS SHUNT PROSTHESIS
L86130HCPCS / CPT®OSSICULAR IMPLANT
L86140HCPCS / CPT®COCHLEAR DEVICE
L86150HCPCS / CPT®COCH IMPLANT HEADSET REPLACE
L86160HCPCS / CPT®COCH IMPLANT MICROPHONE REPL
L86170HCPCS / CPT®COCH IMPLANT TRANS COIL REPL
L86180HCPCS / CPT®COCH IMPLANT TRAN CABLE REPL
L86190HCPCS / CPT®COCH IMP EXT PROC/CONTR RPLC
L86210HCPCS / CPT®REPL ZINC AIR BATTERY
L86220HCPCS / CPT®REPL ALKALINE BATTERY
L86230HCPCS / CPT®LITH ION BATT CID,NON-EARLVL
L86240HCPCS / CPT®LITH ION BATT CID, EAR LEVEL
L86270HCPCS / CPT®CID EXT SPEECH PROCESS REPL
L86280HCPCS / CPT®CID EXT CONTROLLER REPL
L86290HCPCS / CPT®CID TRANSMIT COIL AND CABLE
L86300HCPCS / CPT®METACARPOPHALANGEAL IMPLANT
L86310HCPCS / CPT®MCP JOINT REPL 2 PC OR MORE
L86410HCPCS / CPT®METATARSAL JOINT IMPLANT
L86420HCPCS / CPT®HALLUX IMPLANT
L86580HCPCS / CPT®INTERPHALANGEAL JOINT SPACER
L86590HCPCS / CPT®INTERPHALANGEAL JOINT REPL
L86700HCPCS / CPT®VASCULAR GRAFT, SYNTHETIC
L86790HCPCS / CPT®IMP NEUROSTI PLS GN ANY TYPE
L86800HCPCS / CPT®IMPLT NEUROSTIM ELCTR EACH