2010 HCPCS Schedule - DE Medical Assistance Program

L5781 LOWER LIMB PROS VACUUM PUMP 5 $0.00
L5782 HD LOW LIMB PROS VACUUM PUMP 5 $0.00
L5785 EXOSKELETAL BK ULTRALT MATER 3 $397.43
L5790 EXOSKELETAL AK ULTRA-LIGHT M 3 $550.01
L5795 EXOSKEL HIP ULTRA-LIGHT MATE 3 $821.31
L5810 ENDOSKEL KNEE-SHIN MNL LOCK 3 $382.08
L5811 ENDO KNEE-SHIN MNL LCK ULTRA 3 $557.88
L5812 ENDO KNEE-SHIN FRCT SWG & ST 3 $432.41
L5814 ENDO KNEE-SHIN HYDRAL SWG PH 3 $2,788.88
L5816 ENDO KNEE-SHIN POLYC MCH STA 3 $650.54
L5818 ENDO KNEE-SHIN FRCT SWG & ST 3 $734.59
L5822 ENDO KNEE-SHIN PNEUM SWG FRC 3 $1,425.17
L5824 ENDO KNEE-SHIN FLUID SWING P 3 $1,173.08
L5826 MINIATURE KNEE JOINT 3 $2,368.56
L5828 ENDO KNEE-SHIN FLUID SWG/STA 3 $2,236.15
L5830 ENDO KNEE-SHIN PNEUM/SWG PHA 3 $1,588.87
L5840 MULTI-AXIAL KNEE/SHIN SYSTEM 3 $2,801.79
L5845 KNEE-SHIN SYS STANCE FLEXION 3 $1,345.96
L5846 KNEE-SHIN SYS MICROPROCESSOR O $0.00
L5847 MICROPROCESSOR CNTRL FEATURE O $0.00
L5848 KNEE-SHIN SYS HYDRAUL STANCE 5 $0.00
L5850 ENDO AK/HIP KNEE EXTENS ASSI 3 $101.61
L5855 MECH HIP EXTENSION ASSIST 3 $236.23
L5856 ELEC KNEE-SHIN SWING/STANCE 6 $0.00
L5857 ELEC KNEE-SHIN SWING ONLY 6 $0.00
L5858 STANCE PHASE ONLY 6 $0.00
L5910 ENDO BELOW KNEE ALIGNABLE SY 3 $279.01
L5920 ENDO AK/HIP ALIGNABLE SYSTEM 3 $405.87
L5925 ABOVE KNEE MANUAL LOCK 3 $257.02
L5930 HIGH ACTIVITY KNEE FRAME 3 $2,527.60
L5940 ENDO BK ULTRA-LIGHT MATERIAL 3 $383.70
L5950 ENDO AK ULTRA-LIGHT MATERIAL 3 $648.20
L5960 ENDO HIP ULTRA-LIGHT MATERIA 3 $776.46
L5962 BELOW KNEE FLEX COVER SYSTEM 3 $449.63
L5964 ABOVE KNEE FLEX COVER SYSTEM 3 $805.38
L5966 HIP FLEXIBLE COVER SYSTEM 3 $1,037.45
L5968 MULTIAXIAL ANKLE W DORSIFLEX 3 $2,728.85
L5970 FOOT EXTERNAL KEEL SACH FOOT 3 $167.93
L5971 SACH FOOT, REPLACEMENT 6 $0.00
L5972 FLEXIBLE KEEL FOOT 3 $269.59
L5973 ANK-FOOT SYS DORS-PLANT FLEX 6 $0.00
L5974 FOOT SINGLE AXIS ANKLE/FOOT 3 $227.45
L5975 COMBO ANKLE/FOOT PROSTHESIS 3 $348.14
L5976 ENERGY STORING FOOT 3 $428.39
L5978 FT PROSTH MULTIAXIAL ANKL/FT 3 $223.23
L5979 MULTI-AXIAL ANKLE/FT PROSTH 3 $1,791.29
L5980 FLEX FOOT SYSTEM 3 $2,836.17
L5981 FLEX-WALK SYS LOW EXT PROSTH 3 $2,451.49
L5982 EXOSKELETAL AXIAL ROTATION U 3 $442.22