|
L3201 | Orthopedic shoe, oxford with supinator or pronator, infant |
|
L3202 | Orthopedic shoe, oxford with supinator or pronator, child |
|
L3203 | Orthopedic shoe, oxford with supinator or pronator, junior |
|
L3204 | Orthopedic shoe, hightop with supinator or pronator, infant |
|
L3206 | Orthopedic shoe, hightop with supinator or pronator, child |
|
L3207 | Orthopedic shoe, hightop with supinator or pronator, junior |
|
L3208 | Surgical boot, each, infant |
|
L3209 | Surgical boot, each, child |
|
L3211 | Surgical boot, each, junior |
|
L3212 | Benesch boot, pair, infant |
|
L3213 | Benesch boot, pair, child |
|
L3214 | Benesch boot, pair, junior |
|
L3215 | Orthopedic footwear, ladies shoe, oxford, each |
|
L3216 | Orthopedic footwear, ladies shoe, depth inlay, each |
|
L3217 | Orthopedic footwear, ladies shoe, hightop, depth inlay, each |
|
L3219 | Orthopedic footwear, mens shoe, oxford, each |
|
L3221 | Orthopedic footwear, mens shoe, depth inlay, each |
|
L3222 | Orthopedic footwear, mens shoe, hightop, depth inlay, each |
|
L3224 | Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis) |
|
L3225 | Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis) |
|
L3230 | Orthopedic footwear, custom shoe, depth inlay, each |
|
L3250 | Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each |
|
L3251 | Foot, shoe molded to patient model, silicone shoe, each |
|
L3252 | Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each |
|
L3253 | Foot, molded shoe plastazote (or similar) custom fitted, each |
|
L3254 | Non-standard size or width |
|
L3255 | Non-standard size or length |
|
L3257 | Orthopedic footwear, additional charge for split size |
|
L3260 | Surgical boot/shoe, each |
|
L3265 | Plastazote sandal, each |
