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2010 HCPCS Schedule - DE Medical Assistance Program

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L2265 LONG TONGUE STIRRUP 3 $84.55<br />

L2270 VARUS/VALGUS STRAP PAD<strong>DE</strong>D/LI 3 $39.65<br />

L2275 PLASTIC MOD LOW EXT PAD/LINE 3 $93.48<br />

L2280 MOL<strong>DE</strong>D INNER BOOT 3 $326.87<br />

L2300 ABDUCTION BAR JOINTED ADJUST 3 $204.94<br />

L2310 ABDUCTION BAR-STRAIGHT 3 $102.64<br />

L2320 NON-MOL<strong>DE</strong>D LACER 3 $147.73<br />

L2330 LACER MOL<strong>DE</strong>D TO PATIENT MO<strong>DE</strong> 3 $309.23<br />

L2335 ANTERIOR SWING BAND 3 $190.92<br />

L2340 PRE-TIBIAL SHELL MOL<strong>DE</strong>D TO P 3 $413.33<br />

L2350 PROSTHETIC TYPE SOCKET MOL<strong>DE</strong> 3 $713.86<br />

L2360 EXTEN<strong>DE</strong>D STEEL SHANK 3 $37.15<br />

L2370 PATTEN BOTTOM 3 $240.71<br />

L2375 TORSION ANK & HALF SOLID STI 3 $101.69<br />

L2380 TORSION STRAIGHT KNEE JOINT 3 $88.39<br />

L2385 STRAIGHT KNEE JOINT HEAVY DU 3 $96.17<br />

L2387 ADD LE POLY KNEE CUSTOM KAFO 6 $0.00<br />

L2390 OFFSET KNEE JOINT EACH 3 $80.51<br />

L2395 OFFSET KNEE JOINT HEAVY DUTY 3 $112.34<br />

L2397 SUSPENSION SLEEVE LOWER EXT 3 $87.53<br />

L2405 KNEE JOINT DROP LOCK EA JNT 3 $65.34<br />

L2415 KNEE JOINT CAM LOCK EACH JOI 3 $91.03<br />

L2425 KNEE DISC/DIAL LOCK/ADJ FLEX 3 $107.43<br />

L2430 KNEE JNT RATCHET LOCK EA JNT 3 $107.43<br />

L2435 KNEE JOINT POLYCENTRIC JOINT O $0.00<br />

L2492 KNEE LIFT LOOP DROP LOCK RIN 3 $97.54<br />

L2500 THI/GLUT/ISCHIA WGT BEARING 3 $233.34<br />

L2510 TH/WGHT BEAR QUAD-LAT BRIM M 3 $523.55<br />

L2520 TH/WGHT BEAR QUAD-LAT BRIM C 3 $345.37<br />

L2525 TH/WGHT BEAR NAR M-L BRIM MO 3 $931.80<br />

L2526 TH/WGHT BEAR NAR M-L BRIM CU 3 $531.72<br />

L2530 THIGH/WGHT BEAR LACER NON-MO 3 $168.70<br />

L2540 THIGH/WGHT BEAR LACER MOL<strong>DE</strong>D 3 $303.55<br />

L2550 THIGH/WGHT BEAR HIGH ROLL CU 3 $206.21<br />

L2570 HIP CLEVIS TYPE 2 POSIT JNT 3 $341.99<br />

L2580 PELVIC CONTROL PELVIC SLING 3 $333.23<br />

L2600 HIP CLEVIS/THRUST BEARING FR 3 $182.48<br />

L2610 HIP CLEVIS/THRUST BEARING LO 3 $193.28<br />

L2620 PELVIC CONTROL HIP HEAVY DUT 3 $217.32<br />

L2622 HIP JOINT ADJUSTABLE FLEXION 3 $246.37<br />

L2624 HIP ADJ FLEX EXT ABDUCT CONT 3 $237.76<br />

L2627 PLASTIC MOLD RECIPRO HIP & C 3 $1,297.39<br />

L2628 METAL FRAME RECIPRO HIP & CA 3 $1,276.17<br />

L2630 PELVIC CONTROL BAND & BELT U 3 $177.79<br />

L2640 PELVIC CONTROL BAND & BELT B 3 $241.29<br />

L2650 PELV & THOR CONTROL GLUTEAL 3 $102.75<br />

L2660 THORACIC CONTROL THORACIC BA 3 $133.82<br />

L2670 THORAC CONT PARASPINAL UPRIG 3 $129.79<br />

L2680 THORAC CONT LAT SUPPORT UPRI 3 $120.23

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