fee schedule 2009 new - DE Medical Assistance Program

L7499 5 UPPER EXTREMITY PROSTHES NOS 0.00
L7500 5 PROSTHETIC DVC REPAIR HOURLY 0.00
L7510 5 PROSTHETIC DEVICE REPAIR REP 0.00
L7520 3 REPAIR PROSTHESIS PER 15 MIN 6.25
L7600 6 PROSTHETIC DONNING SLEEVE 0.00
L7611 O PED TERM DEV, HOOK, VOL OPEN 0.00
L7612 O PED TERM DEV, HOOK, VOL CLOS 0.00
L7613 O PED TERM DEV, HAND, VOL OPEN 0.00
L7614 O PED TERM DEV, HAND, VOL CLOS 0.00
L7621 O HOOK/HAND, HVY DTY, VOL OPEN 0.00
L7622 O HOOK/HAND, HVY DTY, VOL CLOS 0.00
L7900 9 VACUUM ERECTION SYSTEM 0.00
L8000 3 MASTECTOMY BRA 27.93
L8001 5 BREAST PROSTHESIS BRA & FORM 0.00
L8002 5 BRST PRSTH BRA & BILAT FORM 0.00
L8010 3 MASTECTOMY SLEEVE 46.39
L8015 3 EXT BREASTPROSTHESIS GARMENT 45.02
L8020 3 MASTECTOMY FORM 191.37
L8030 3 BREAST PROSTHESIS SILICONE/E 247.69
L8035 3 CUSTOM BREAST PROSTHESIS 2,751.16
L8039 5 BREAST PROSTHESIS NOS 0.00
L8040 3 NASAL PROSTHESIS 1,294.46
L8041 3 MIDFACIAL PROSTHESIS 1,560.25
L8042 3 ORBITAL PROSTHESIS 1,753.08
L8043 3 UPPER FACIAL PROSTHESIS 1,963.45
L8044 3 HEMI-FACIAL PROSTHESIS 2,173.82
L8045 3 AURICULAR PROSTHESIS 1,517.49
L8046 3 PARTIAL FACIAL PROSTHESIS 1,402.47
L8047 3 NASAL SEPTAL PROSTHESIS 718.77
L8048 5 UNSPEC MAXILLOFACIAL PROSTH 0.00
L8049 3 REPAIR MAXILLOFACIAL PROSTH 15.69
L8100 O COMPRESSION STOCKING BK18-30 0.00
L8110 O COMPRESSION STOCKING BK30-40 0.00
L8120 O COMPRESSION STOCKING BK40-50 0.00
L8130 O GC STOCKING THIGHLNGTH 18-30 0.00
L8140 O GC STOCKING THIGHLNGTH 30-40 0.00
L8150 O GC STOCKING THIGHLNGTH 40-50 0.00
L8160 O GC STOCKING FULL LNGTH 18-30 0.00
L8170 O GC STOCKING FULL LNGTH 30-40 0.00
L8180 O GC STOCKING FULL LNGTH 40-50 0.00
L8190 O GC STOCKING WAISTLNGTH 18-30 0.00
L8195 O GC STOCKING WAISTLNGTH 30-40 0.00
L8200 O GC STOCKING WAISTLNGTH 40-50 0.00
L8210 O GC STOCKING CUSTOM MADE 0.00
L8220 O GC STOCKING LYMPHEDEMA 0.00
L8230 O GC STOCKING GARTER BELT 0.00
L8239 O G COMPRESSION STOCKING NOS 0.00
L8300 3 TRUSS SINGLE W/ STANDARD PAD 64.52
L8310 3 TRUSS DOUBLE W/ STANDARD PAD 101.87
L8320 3 TRUSS ADDITION TO STD PAD WA 45.67