Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
Medicaid Fee Schedule without Mods 200801
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PROC-CODE DESC MAC BEG END<br />
L2670<br />
ADDITION TO LOWER EXTREMITY,THORACIC CNTRL,PARASPINAL<br />
UPRGTS $102.91 20060701 99999999<br />
L2680<br />
ADDITION TO LOWER EXTREMITY,THORACIC CONTROL,LATERAL<br />
SUPPORT $90.39 20060701 99999999<br />
L2750<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,PLATING CHROME OR<br />
NICKE $36.56 20060701 99999999<br />
L2755<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS, CARBON GRAPHITE<br />
LAMINATION $106.78 20060701 99999999<br />
L2760<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,EXTENSION,PER<br />
EXTENSION $62.29 20060701 99999999<br />
L2768 ORTHOTIC SIDE BAR DISCONNECT DEVICE, PER BAR $61.43 20060701 99999999<br />
L2770<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,STAINLESS STEE-PER<br />
BAR $46.96 20060701 99999999<br />
L2780 ADDITION TO LOWER EXTREMITY ORTHOSIS,NON-CORROSIVE FINISH $48.74 20060701 99999999<br />
L2785<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,DROP LOCK<br />
RETAINER,EACH $28.68 20060701 99999999<br />
L2795<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,KNEE CONTROL,FULL<br />
KNEE $68.92 20060701 99999999<br />
L2800<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,KNEE CONTROL,KNEE<br />
CAP $84.76 20060701 99999999<br />
L2810<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,KNEE<br />
CONTROL,CONDYLAR $68.28 20060701 99999999<br />
L2820<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,SOFT INTERFACE FOR<br />
MOLD $102.02 20060701 99999999<br />
L2830<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,SOFT INTERFACE FOR<br />
MOLD $85.90 20060701 99999999<br />
L2840 ADDDITION TO LOWER EXTREMITY ORTHOSIS,TIBIAL LENGTH SOCK $21.25 20060701 99999999<br />
L2850<br />
ADDITION TO LOWER EXTREMITY ORTHOSIS,FEMORAL LENGTH<br />
SOCK,FX $35.74 20060701 99999999<br />
L2860<br />
ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE,<br />
CONCENTRIC ADJUSTABLE TORSION $267.64 20030401 99999999<br />
L2999 UNLISTED PROCEDURES FOR LOWER EXTREMITY ORTHOSES $29.12 20030401 99999999<br />
L3000 FOOT,INSERT,REMOVABLE,MOLDED TO PATIENT MODEL,"UCB" TYPE $148.10 20060701 99999999<br />
L3001<br />
FOOT,INSERT,REMOVABLE,MOLDED TO PATIENT MODEL<br />
SPENCO,EACH $62.35 20060701 99999999<br />
L3002<br />
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL,<br />
PLASTAZOTE $76.14 20060701 99999999<br />
L3003<br />
FOOT,INSERT,REMOVABLE,MOLDED TO PATIENT MODEL,SILICONE<br />
GEL,E $82.15 20060701 99999999<br />
L3010<br />
FOOT,INSSER,REMOVABLE,MOLDED TO PATIENT<br />
MODEL,LONGITUDINAL $82.15 20060701 99999999<br />
L3020<br />
FOOT,INSERT,REMOVABLE,MOLDED TO PATIENT MODEL<br />
LONGITUDINAL $93.55 20060701 99999999<br />
L3030 FOOT,INSERT,REMOVABLE,FORMED TO PATIENT FOOT,EACH $35.98 20060701 99999999<br />
L3031<br />
FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY<br />
ORTHOSIS, HIGH STRENG $5.99 20071101 99999999<br />
L3040<br />
FOOT,ARCH<br />
SUPPORT,REMOVABLE,PREMOLDED,LONGITUDINAL,EACH $22.18 20060701 99999999<br />
L3050 FOOT,ARCH SUPPORT,REMOVABLE,PREMOLDED,METATARSAL,EACH $22.18 20060701 99999999<br />
L3060<br />
FOOT,ARCH<br />
SUPPORT,REMOVABLE,PREMOLDED,LONGITUDINAL/METATARSA $34.78 20060701 99999999<br />
L3070<br />
FOOT,ARCH SUPPORT,NON-REMOVABLE ATTACHED TO<br />
SHOE,LONGITUDINA $14.98 20060701 99999999<br />
L3080<br />
FOOT,ARCH SUPPORT,NON-REMOVABLE ATTACHED TO<br />
SHOE,METATARSAL $14.98 20060701 99999999<br />
L3090<br />
FOOT,ARCH SUPPORT,NON-REMOVABLE ATTACHED TO<br />
SHOE,LONGITUDINA $19.19 20060701 99999999<br />
Hawaii <strong>Medicaid</strong> <strong>Fee</strong> <strong>Schedule</strong> <strong>without</strong> <strong>Mods</strong> 01/2008 57