HCPC Long Description Short Description
A4580 CAST SUPPLIES (E.G. PLASTER) Cast supplies (plaster)
A4590 SPECIAL CASTING MATERIAL (E.G. FIBERGLASS) Special casting material
A5500 FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND Diab shoe for density insert
SUPPLY OF OFF-THE-SHELF DEPTH-INLAY SHOE MANUFACTURED TO ACCOMMODATE MULTI-
A5500 DENSITY INSERT(S), PER SHOE
A5501 FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP), CUSTOM PREPARATION AND Diabetic custom molded shoe
SUPPLY OF SHOE MOLDED FROM CAST(S) OF PATIENT'S FOOT (CUSTOM MOLDED SHOE), PER
SHOE
A5503 FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF Diabetic shoe w/roller/rockr
DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH ROLLER OR RIGID ROCKER BOTTOM, PER
SHOE
A5504 FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF Diabetic shoe with wedge
DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH WEDGE(S), PER SHOE
A5505 FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF Diab shoe w/metatarsal bar
DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH METATARSAL BAR, PER SHOE
A5506 FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF Diabetic shoe w/off set heel
DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH OFF-SET HEEL(S), PER SHOE
A5507 FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF Modification diabetic shoe
OFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE, PER SHOE
A5508 FOR DIABETICS ONLY, DELUXE FEATURE OF OFF-THE-SHELF DEPTH-INLAY SHOE OR Diabetic deluxe shoe
CUSTOM-MOLDED SHOE, PER SHOE
A5509 FOR DIABETICS ONLY, DIRECT FORMED, MOLDED TO FOOT WITH EXTERNAL HEAT SOURCE Direct heat form shoe insert
(I.E. HEAT GUN) MULTIPLE DENSITY INSERT (S), PREFABRICATED, PER SHOE
A5510 FOR DIABETICS ONLY, DIRECT FORMED, COMPRESSION MOLDED TO PATIENT'S FOOT WITHOUT Compression form shoe insert
EXTERNAL HEAT SOURCE, MULTIPLE-DENSITY INSERT(S) PREFABRICATED, PER SHOE
A5511 FOR DIABETICS ONLY, CUSTOM-MOLDED FROM MODEL OF PATIENT'S FOOT, MULTIPLE Custom fab molded shoe inser
DENSITY INSERT(S), CUSTOM-FABRICATED, PER SHOE
A5512 FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT Multi den insert direct form
AFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT
WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF
SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER),
PREFABRICATED, EACH
A5513 FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF Multi den insert custom mold
PATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER
MINIMUM OF 3/16 INCH MATERIAL OF SHORE A 35 DUROMETER OR HIGHER), INCLUDES ARCH
FILLER AND OTHER SHAPING MATERIAL, CUSTOM FABRICATED, EACH
A9283 FOOT PRESSURE OFF LOADING/SUPPORTIVE DEVICE, ANY TYPE, EACH Foot press off load supp dev
G0245 INITIAL PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH DIABETIC Initial foot exam pt lops
SENSORY NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS) WHICH
MUST INCLUDE: (1) THE DIAGNOSIS OF LOPS, (2) A PATIENT HISTORY, (3) A PHYSICAL
EXAMINATION THAT CONSISTS OF AT LEAST THE FOLLOWING ELEMENTS: (A) VISUAL
INSPECTION OF THE FOREFOOT, HINDFOOT AND TOE WEB SPACES, (B)EVALUATION OF A
PROTECTIVE SENSATION, (C) EVALUATION OF FOOT STRUCTURE AND BIOMECHANICS, (D)
EVALUATION OF VASCULAR STATUS AND SKIN INTEGRITY, AND (E) EVALUATION AND
RECOMMENDATION OF FOOTWEAR AND (4) PATIENT EDUCATION
G0246 FOLLOW-UP PHYSICIAN EVALUATION AND MANAGEMENT OF A DIABETIC PATIENT WITH Followup eval of foot pt lop
DIABETIC SENSORY NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS)
TO INCLUDE AT LEAST THE FOLLOWING: (1) A PATIENT HISTORY, (2) A PHYSICAL
EXAMINATION THAT INCLUDES: (A) VISUAL INSPECTION OF THE FOREFOOT, HINDFOOT AND
TOE WEB SPACES, (B) EVALUATION OF PROTECTIVE SENSATION, (C) EVALUATION OF FOOT
STRUCTURE AND BIOMECHANICS, (D) EVALUATION OF VASCULAR STATUS AND SKIN
INTEGRITY, AND (E) EVALUATION AND RECOMMENDATION OF FOOTWEAR, AND (3) PATIENT
EDUCATION
G0247 ROUTINE FOOT CARE BY A PHYSICIAN OF A DIABETIC PATIENT WITH DIABETIC SENSORY Routine footcare pt w lops
NEUROPATHY RESULTING IN A LOSS OF PROTECTIVE SENSATION (LOPS) TO INCLUDE, THE
LOCAL CARE OF SUPERFICIAL WOUNDS (I.E. SUPERFICIAL TO MUSCLE AND FASCIA) AND AT
LEAST THE FOLLOWING IF PRESENT: (1) LOCAL CARE OF SUPERFICIAL WOUNDS, (2)
DEBRIDEMENT OF CORNS AND CALLUSES, AND (3) TRIMMING AND DEBRIDEMENT OF NAILS
G8410 FOOTWEAR EVALUATION PERFORMED AND DOCUMENTED Eval on foot documented
G8415 FOOTWEAR EVALUATION WAS NOT PERFORMED Eval on foot not performed
G8416 CLINICIAN DOCUMENTED THAT PATIENT WAS NOT AN ELIGIBLE CANDIDATE FOR FOOTWEAR Pt inelig footwear evaluatio
EVALUATION MEASURE
K0628 FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT Multi den insert direct form
AFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT
WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF 1/4 INCH MATERIAL OF
SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER),
PREFABRICATED, EACH
K0629 FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, CUSTOM MOLDED FROM MODEL OF Multi den insert custom mold
PATIENT'S FOOT, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER
MINIMUM OF 3/16 INCH MATERIAL OF SHORE A 35 DUROMETER OR HIGHER, INCLUDES ARCH
FILLER AND OTHER SHAPING MATERIAL, CUSTOM FABRICATED, EACH
L1900 ANKLE FOOT ORTHOSIS, SPRING WIRE, DORSIFLEXION ASSIST CALF BAND, Afo sprng wir drsflx calf bd
CUSTOM-FABRICATED
L1901 ANKLE ORTHOSIS, ELASTIC, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT (E.G. Prefab ankle orthosis
NEOPRENE, LYCRA)
L1902 ANKLE FOOT ORTHOSIS, ANKLE GAUNTLET, PREFABRICATED, INCLUDES FITTING AND Afo ankle gauntlet
ADJUSTMENT
L1904 ANKLE FOOT ORTHOSIS, MOLDED ANKLE GAUNTLET, CUSTOM-FABRICATED Afo molded ankle gauntlet
L1906 ANKLE FOOT ORTHOSIS, MULTILIGAMENTUS ANKLE SUPPORT, PREFABRICATED, INCLUDES Afo multiligamentus ankle su
FITTING AND ADJUSTMENT
L1907 AFO, SUPRAMALLEOLAR WITH STRAPS, WITH OR WITHOUT INTERFACE/PADS, CUSTOM AFO supramalleolar custom
FABRICATED
L1910 ANKLE FOOT ORTHOSIS, POSTERIOR, SINGLE BAR, CLASP ATTACHMENT TO SHOE COUNTER, Afo sing bar clasp attach sh
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L1920 ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT WITH STATIC OR ADJUSTABLE STOP (PHELPS OR Afo sing upright w/ adjust s
PERLSTEIN TYPE), CUSTOM-FABRICATED
L1930 ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING Afo plastic
AND ADJUSTMENT
L1932 AFO, RIGID ANTERIOR TIBIAL SECTION, TOTAL CARBON FIBER OR EQUAL MATERIAL, Afo rig ant tib prefab TCF/=
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L1940 ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL, CUSTOM-FABRICATED Afo molded to patient plasti
L1945 ANKLE FOOT ORTHOSIS, PLASTIC, RIGID ANTERIOR TIBIAL SECTION (FLOOR REACTION), Afo molded plas rig ant tib
CUSTOM-FABRICATED
L1950 ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), Afo spiral molded to pt plas
PLASTIC, CUSTOM-FABRICATED
L1951 ANKLE FOOT ORTHOSIS, SPIRAL, (INSTITUTE OF REHABILITATIVE MEDICINE TYPE), AFO spiral prefabricated
PLASTIC OR OTHER MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L1960 ANKLE FOOT ORTHOSIS, POSTERIOR SOLID ANKLE, PLASTIC, CUSTOM-FABRICATED Afo pos solid ank plastic mo
L1970 ANKLE FOOT ORTHOSIS, PLASTIC WITH ANKLE JOINT, CUSTOM-FABRICATED Afo plastic molded w/ankle j
L1971 ANKLE FOOT ORTHOSIS, PLASTIC OR OTHER MATERIAL WITH ANKLE JOINT, PREFABRICATED, AFO w/ankle joint, prefab
INCLUDES FITTING AND ADJUSTMENT
L1980 ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, Afo sing solid stirrup calf
CALF BAND/CUFF (SINGLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED
L1990 ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLID STIRRUP, Afo doub solid stirrup calf
CALF BAND/CUFF (DOUBLE BAR 'BK' ORTHOSIS), CUSTOM-FABRICATED
L2000 KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE KNEE, FREE ANKLE, SOLID STIRRUP, Kafo sing fre stirr thi/calf
THIGH AND CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED
L2005 KNEE ANKLE FOOT ORTHOSIS, ANY MATERIAL, SINGLE OR DOUBLE UPRIGHT, STANCE KAFO sng/dbl mechanical act
CONTROL, AUTOMATIC LOCK AND SWING PHASE RELEASE, MECHANICAL ACTIVATION,
INCLUDES ANKLE JOINT, ANY TYPE, CUSTOM FABRICATED
L2010 KNEE ANKLE FOOT ORTHOSIS, SINGLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND Kafo sng solid stirrup w/o j
CALF BANDS/CUFFS (SINGLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT,
CUSTOM-FABRICATED
L2020 KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND Kafo dbl solid stirrup band/
CALF BANDS/CUFFS (DOUBLE BAR 'AK' ORTHOSIS), CUSTOM-FABRICATED
L2030 KNEE ANKLE FOOT ORTHOSIS, DOUBLE UPRIGHT, FREE ANKLE, SOLID STIRRUP, THIGH AND Kafo dbl solid stirrup w/o j
CALF BANDS/CUFFS, (DOUBLE BAR 'AK' ORTHOSIS), WITHOUT KNEE JOINT, CUSTOM
FABRICATED
L2034 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE KAFO pla sin up w/wo k/a cus
MOTION KNEE, MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION
ANKLE, CUSTOM FABRICATED
L2035 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, STATIC (PEDIATRIC SIZE), WITHOUT FREE KAFO plastic pediatric size
MOTION ANKLE, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L2036 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, DOUBLE UPRIGHT, WITH OR WITHOUT FREE Kafo plas doub free knee mol
MOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED
L2037 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, WITH OR WITHOUT FREE Kafo plas sing free knee mol
MOTION KNEE, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM FABRICATED
L2038 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, WITH OR WITHOUT FREE MOTION KNEE, Kafo w/o joint multi-axis an
MULTI-AXIS ANKLE, CUSTOM FABRICATED
L2039 KNEE ANKLE FOOT ORTHOSIS, FULL PLASTIC, SINGLE UPRIGHT, POLY-AXIAL HINGE, KAFO,plstic,medlat rotat con
MEDIAL LATERAL ROTATION CONTROL, WITH OR WITHOUT FREE MOTION ANKLE, CUSTOM
FABRICATED
L2040 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL ROTATION STRAPS, Hkafo torsion bil rot straps
PELVIC BAND/BELT, CUSTOM FABRICATED
L2050 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, HIP Hkafo torsion cable hip pelv
JOINT, PELVIC BAND/BELT, CUSTOM-FABRICATED
L2060 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, BILATERAL TORSION CABLES, BALL Hkafo torsion ball bearing j
BEARING HIP JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED
L2070 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL ROTATION STRAPS, Hkafo torsion unilat rot str
PELVIC BAND/BELT, CUSTOM FABRICATED
L2080 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, HIP Hkafo unilat torsion cable
JOINT, PELVIC BAND/BELT, CUSTOM-FABRICATED
L2090 HIP KNEE ANKLE FOOT ORTHOSIS, TORSION CONTROL, UNILATERAL TORSION CABLE, BALL Hkafo unilat torsion ball br
BEARING HIP JOINT, PELVIC BAND/ BELT, CUSTOM-FABRICATED
L2106 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, Afo tib fx cast plaster mold
THERMOPLASTIC TYPE CASTING MATERIAL, CUSTOM-FABRICATED
L2108 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE CAST ORTHOSIS, Afo tib fx cast molded to pt
CUSTOM-FABRICATED
L2112 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT, Afo tibial fracture soft
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L2114 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-RIGID, Afo tib fx semi-rigid
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L2116 ANKLE FOOT ORTHOSIS, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, RIGID, Afo tibial fracture rigid
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L3000 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, 'UCB' TYPE, BERKELEY SHELL, Ft insert ucb berkeley shell
EACH
L3001 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SPENCO, EACH Foot insert remov molded spe
L3002 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, PLASTAZOTE OR EQUAL, EACH Foot insert plastazote or eq
L3003 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, SILICONE GEL, EACH Foot insert silicone gel eac
L3010 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL ARCH SUPPORT, Foot longitudinal arch suppo
EACH
L3020 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, LONGITUDINAL/ METATARSAL Foot longitud/metatarsal sup
SUPPORT, EACH
L3030 FOOT, INSERT, REMOVABLE, FORMED TO PATIENT FOOT, EACH Foot arch support remov prem
L3031 FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH Foot lamin/prepreg composite
STRENGTH, LIGHTWEIGHT MATERIAL, ALL HYBRID LAMINATION/PREPREG COMPOSITE, EACH
L3040 FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL, EACH Ft arch suprt premold longit
L3050 FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, METATARSAL, EACH Foot arch supp premold metat
L3060 FOOT, ARCH SUPPORT, REMOVABLE, PREMOLDED, LONGITUDINAL/ METATARSAL, EACH Foot arch supp longitud/meta
L3070 FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL, EACH Arch suprt att to sho longit
L3080 FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, METATARSAL, EACH Arch supp att to shoe metata
L3090 FOOT, ARCH SUPPORT, NON-REMOVABLE ATTACHED TO SHOE, LONGITUDINAL/METATARSAL, Arch supp att to shoe long/m
EACH
L3100 HALLUS-VALGUS NIGHT DYNAMIC SPLINT Hallus-valgus nght dynamic s
L3140 FOOT, ABDUCTION ROTATION BAR, INCLUDING SHOES Abduction rotation bar shoe
L3150 FOOT, ABDUCTION ROTATATION BAR, WITHOUT SHOES Abduct rotation bar w/o shoe
L3160 FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE Shoe styled positioning dev
L3170 FOOT, PLASTIC, SILICONE OR EQUAL, HEEL STABILIZER, EACH Foot plastic heel stabilizer
L3201 ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, INFANT Oxford w supinat/pronat inf
L3202 ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, CHILD Oxford w/ supinat/pronator c
L3203 ORTHOPEDIC SHOE, OXFORD WITH SUPINATOR OR PRONATOR, JUNIOR Oxford w/ supinator/pronator
L3204 ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT Hightop w/ supp/pronator inf
L3206 ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, CHILD Hightop w/ supp/pronator chi
L3207 ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, JUNIOR Hightop w/ supp/pronator jun
L3208 SURGICAL BOOT, EACH, INFANT Surgical boot each infant
L3209 SURGICAL BOOT, EACH, CHILD Surgical boot each child
L3211 SURGICAL BOOT, EACH, JUNIOR Surgical boot each junior
L3212 BENESCH BOOT, PAIR, INFANT Benesch boot pair infant
L3213 BENESCH BOOT, PAIR, CHILD Benesch boot pair child
L3214 BENESCH BOOT, PAIR, JUNIOR Benesch boot pair junior
L3215 ORTHOPEDIC FOOTWEAR, LADIES SHOE, OXFORD, EACH Orthopedic ftwear ladies oxf
L3216 ORTHOPEDIC FOOTWEAR, LADIES SHOE, DEPTH INLAY, EACH Orthoped ladies shoes dpth i
L3217 ORTHOPEDIC FOOTWEAR, LADIES SHOE, HIGHTOP, DEPTH INLAY, EACH Ladies shoes hightop depth i
L3219 ORTHOPEDIC FOOTWEAR, MENS SHOE, OXFORD, EACH Orthopedic mens shoes oxford
L3221 ORTHOPEDIC FOOTWEAR, MENS SHOE, DEPTH INLAY, EACH Orthopedic mens shoes dpth i
L3222 ORTHOPEDIC FOOTWEAR, MENS SHOE, HIGHTOP, DEPTH INLAY, EACH Mens shoes hightop depth inl
L3224 ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE Woman's shoe oxford brace
(ORTHOSIS)
L3225 ORTHOPEDIC FOOTWEAR, MAN'S SHOE, OXFORD, USED AS AN INTEGRAL PART OF A BRACE Man's shoe oxford brace
(ORTHOSIS)
L3230 ORTHOPEDIC FOOTWEAR, CUSTOM SHOE, DEPTH INLAY, EACH Custom shoes depth inlay
L3250 ORTHOPEDIC FOOTWEAR, CUSTOM MOLDED SHOE, REMOVABLE INNER MOLD, PROSTHETIC SHOE, Custom mold shoe remov prost
EACH
L3251 FOOT, SHOE MOLDED TO PATIENT MODEL, SILICONE SHOE, EACH Shoe molded to pt silicone s
L3252 FOOT, SHOE MOLDED TO PATIENT MODEL, PLASTAZOTE (OR SIMILAR), CUSTOM FABRICATED, Shoe molded plastazote cust
EACH
L3253 FOOT, MOLDED SHOE PLASTAZOTE (OR SIMILAR) CUSTOM FITTED, EACH Shoe molded plastazote cust
L3254 NON-STANDARD SIZE OR WIDTH Orth foot non-stndard size/w
L3255 NON-STANDARD SIZE OR LENGTH Orth foot non-standard size/
L3257 ORTHOPEDIC FOOTWEAR, ADDITIONAL CHARGE FOR SPLIT SIZE Orth foot add charge split s
L3260 SURGICAL BOOT/SHOE, EACH Ambulatory surgical boot eac
L3265 PLASTAZOTE SANDAL, EACH Plastazote sandal each
L3300 LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PER INCH Sho lift taper to metatarsal
L3310 LIFT, ELEVATION, HEEL AND SOLE, NEOPRENE, PER INCH Shoe lift elev heel/sole neo
L3320 LIFT, ELEVATION, HEEL AND SOLE, CORK, PER INCH Shoe lift elev heel/sole cor
L3330 LIFT, ELEVATION, METAL EXTENSION (SKATE) Lifts elevation metal extens
L3332 LIFT, ELEVATION, INSIDE SHOE, TAPERED, UP TO ONE-HALF INCH Shoe lifts tapered to one-ha
L3334 LIFT, ELEVATION, HEEL, PER INCH Shoe lifts elevation heel /i
L3340 HEEL WEDGE, SACH Shoe wedge sach
L3350 HEEL WEDGE Shoe heel wedge
L3360 SOLE WEDGE, OUTSIDE SOLE Shoe sole wedge outside sole
L3370 SOLE WEDGE, BETWEEN SOLE Shoe sole wedge between sole
L3380 CLUBFOOT WEDGE Shoe clubfoot wedge
L3390 OUTFLARE WEDGE Shoe outflare wedge
L3400 METATARSAL BAR WEDGE, ROCKER Shoe metatarsal bar wedge ro
L3410 METATARSAL BAR WEDGE, BETWEEN SOLE Shoe metatarsal bar between
L3420 FULL SOLE AND HEEL WEDGE, BETWEEN SOLE Full sole/heel wedge btween
L3430 HEEL, COUNTER, PLASTIC REINFORCED Sho heel count plast reinfor
L3440 HEEL, COUNTER, LEATHER REINFORCED Heel leather reinforced
L3450 HEEL, SACH CUSHION TYPE Shoe heel sach cushion type
L3455 HEEL, NEW LEATHER, STANDARD Shoe heel new leather standa
L3460 HEEL, NEW RUBBER, STANDARD Shoe heel new rubber standar
L3465 HEEL, THOMAS WITH WEDGE Shoe heel thomas with wedge
L3470 HEEL, THOMAS EXTENDED TO BALL Shoe heel thomas extend to b
L3480 HEEL, PAD AND DEPRESSION FOR SPUR Shoe heel pad & depress for
L3485 HEEL, PAD, REMOVABLE FOR SPUR Shoe heel pad removable for
L3500 ORTHOPEDIC SHOE ADDITION, INSOLE, LEATHER Ortho shoe add leather insol
L3510 ORTHOPEDIC SHOE ADDITION, INSOLE, RUBBER Orthopedic shoe add rub insl
L3520 ORTHOPEDIC SHOE ADDITION, INSOLE, FELT COVERED WITH LEATHER O shoe add felt w leath insl
L3530 ORTHOPEDIC SHOE ADDITION, SOLE, HALF Ortho shoe add half sole
L3540 ORTHOPEDIC SHOE ADDITION, SOLE, FULL Ortho shoe add full sole
L3550 ORTHOPEDIC SHOE ADDITION, TOE TAP STANDARD O shoe add standard toe tap
L3560 ORTHOPEDIC SHOE ADDITION, TOE TAP, HORSESHOE O shoe add horseshoe toe tap
L3570 ORTHOPEDIC SHOE ADDITION, SPECIAL EXTENSION TO INSTEP (LEATHER WITH EYELETS) O shoe add instep extension
L3580 ORTHOPEDIC SHOE ADDITION, CONVERT INSTEP TO VELCRO CLOSURE O shoe add instep velcro clo
L3590 ORTHOPEDIC SHOE ADDITION, CONVERT FIRM SHOE COUNTER TO SOFT COUNTER O shoe convert to sof counte
L3595 ORTHOPEDIC SHOE ADDITION, MARCH BAR Ortho shoe add march bar
L3600 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, EXISTING Trans shoe calip plate exist
L3610 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPER PLATE, NEW Trans shoe caliper plate new
L3620 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, EXISTING Trans shoe solid stirrup exi
L3630 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLID STIRRUP, NEW Trans shoe solid stirrup new
L3640 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, DENNIS BROWNE SPLINT Shoe dennis browne splint bo
(RIVETON), BOTH SHOES
L3649 ORTHOPEDIC SHOE, MODIFICATION, ADDITION OR TRANSFER, NOT OTHERWISE SPECIFIED Orthopedic shoe modifica NOS
L4205 REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15 MINUTES Ortho dvc repair per 15 min
L4210 REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINOR PARTS Orth dev repair/repl minor p
L4350 ANKLE CONTROL ORTHOSIS, STIRRUP STYLE, RIGID, INCLUDES ANY TYPE INTERFACE Ankle control orthosi prefab
(E.G., PNEUMATIC, GEL), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L4360 WALKING BOOT, PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE Pneumati walking boot prefab
MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L4370 PNEUMATIC FULL LEG SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT Pneumatic full leg splint
L4380 PNEUMATIC KNEE SPLINT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT Pneumatic knee splint
L4386 WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE Non-pneum walk boot prefab
MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L4392 REPLACEMENT, SOFT INTERFACE MATERIAL, STATIC AFO Replace AFO soft interface
L4394 REPLACE SOFT INTERFACE MATERIAL, FOOT DROP SPLINT Replace foot drop spint
L4396 STATIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR Static AFO
FIT, FOR POSITIONING, PRESSURE REDUCTION, MAY BE USED FOR MINIMAL AMBULATION,
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L4398 FOOT DROP SPLINT, RECUMBENT POSITIONING DEVICE, PREFABRICATED, INCLUDES FITTING Foot drop splint recumbent
AND ADJUSTMENT
L5000 PARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER Sho insert w arch toe filler
L5010 PARTIAL FOOT, MOLDED SOCKET, ANKLE HEIGHT, WITH TOE FILLER Mold socket ank hgt w/ toe f
L5020 PARTIAL FOOT, MOLDED SOCKET, TIBIAL TUBERCLE HEIGHT, WITH TOE FILLER Tibial tubercle hgt w/ toe f
L5050 ANKLE, SYMES, MOLDED SOCKET, SACH FOOT Ank symes mold sckt sach ft
L5060 ANKLE, SYMES, METAL FRAME, MOLDED LEATHER SOCKET, ARTICULATED ANKLE/FOOT Symes met fr leath socket ar
Q4037 CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER Cast sup shrt leg plaster
Q4038 CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS Cast sup shrt leg fiberglass
Q4039 CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER Cast sup shrt leg ped plster
Q4040 CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS Cast sup shrt leg ped fbrgls
Q4045 CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), PLASTER Cast sup sht leg splnt plstr
Q4046 CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS Cast sup sht leg splnt fbrgl
Q4047 CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER Cast sup sht leg splnt ped p
Q4048 CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS Cast sup sht leg splnt ped f
Q4049 FINGER SPLINT, STATIC Finger splint, static
Q4050 CAST SUPPLIES, FOR UNLISTED TYPES AND MATERIALS OF CASTS Cast supplies unlisted
Q4051 SPLINT SUPPLIES, MISCELLANEOUS (INCLUDES THERMOPLASTICS, STRAPPING, FASTENERS, Splint supplies misc
PADDING AND OTHER SUPPLIES)
47 Heisser Lane
Farmingdale, NY 11735
Phone (516) 694-3117 or (800) 451-1719 / Fax (516) 694-2839

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