2010 HCPCS Schedule - DE Medical Assistance Program

L5666 BELOW KNEE CUFF SUSPENSION 3 $58.20
L5667 SOCKET INSERT W LOCK LOWER O $0.00
L5668 SOCKET INSERT W/O LOCK LOWER 3 $77.71
L5669 BELOW KNEE SOCKET W/O LOCK O $0.00
L5670 BK MOLDED SUPRACONDYLAR SUSP 3 $236.56
L5671 BK/AK LOCKING MECHANISM 5 $0.00
L5672 BK REMOVABLE MEDIAL BRIM SUS 3 $289.06
L5673 SOCKET INSERT W LOCK MECH 6 $0.00
L5674 BK SUSPENSION SLEEVE O $0.00
L5675 BK HEAVY DUTY SUSP SLEEVE O $0.00
L5676 BK KNEE JOINTS SINGLE AXIS P 3 $277.19
L5677 BK KNEE JOINTS POLYCENTRIC P 3 $377.16
L5678 BK JOINT COVERS PAIR 3 $30.37
L5679 SOCKET INSERT W/O LOCK MECH 6 $0.00
L5680 BK THIGH LACER NON-MOLDED 3 $264.93
L5681 INTL CUSTM CONG/LATYP INSERT 6 $0.00
L5682 BK THIGH LACER GLUT/ISCHIA M 3 $478.39
L5683 INITIAL CUSTOM SOCKET INSERT 6 $0.00
L5684 BK FORK STRAP 3 $36.81
L5685 BELOW KNEE SUS/SEAL SLEEVE 6 $0.00
L5686 BK BACK CHECK 3 $49.66
L5688 BK WAIST BELT WEBBING 3 $46.72
L5690 BK WAIST BELT PADDED AND LIN 3 $90.49
L5692 AK PELVIC CONTROL BELT LIGHT 3 $105.02
L5694 AK PELVIC CONTROL BELT PAD/L 3 $138.77
L5695 AK SLEEVE SUSP NEOPRENE/EQUA 3 $145.59
L5696 AK/KNEE DISARTIC PELVIC JOIN 3 $159.10
L5697 AK/KNEE DISARTIC PELVIC BAND 3 $64.62
L5698 AK/KNEE DISARTIC SILESIAN BA 3 $80.36
L5699 SHOULDER HARNESS 3 $142.63
L5700 REPLACE SOCKET BELOW KNEE 3 $2,203.73
L5701 REPLACE SOCKET ABOVE KNEE 3 $2,733.93
L5702 REPLACE SOCKET HIP 3 $3,445.70
L5703 SYMES ANKLE W/O (SACH) FOOT 6 $0.00
L5704 CUSTOM SHAPE COVER BK 3 $449.33
L5705 CUSTOM SHAPE COVER AK 3 $823.79
L5706 CUSTOM SHAPE CVR KNEE DISART 3 $803.52
L5707 CUSTOM SHAPE CVR HIP DISART 3 $1,079.50
L5710 KNE-SHIN EXO SNG AXI MNL LOC 3 $275.12
L5711 KNEE-SHIN EXO MNL LOCK ULTRA 3 $417.34
L5712 KNEE-SHIN EXO FRICT SWG & ST 3 $329.61
L5714 KNEE-SHIN EXO VARIABLE FRICT 3 $339.91
L5716 KNEE-SHIN EXO MECH STANCE PH 3 $557.52
L5718 KNEE-SHIN EXO FRCT SWG & STA 3 $696.84
L5722 KNEE-SHIN PNEUM SWG FRCT EXO 3 $727.18
L5724 KNEE-SHIN EXO FLUID SWING PH 3 $1,154.61
L5726 KNEE-SHIN EXT JNTS FLD SWG E 3 $1,516.14
L5728 KNEE-SHIN FLUID SWG & STANCE 3 $1,888.89
L5780 KNEE-SHIN PNEUM/HYDRA PNEUM 3 $910.73