ANEST_BU
0
BETOS
D1F
Long Description
Addition to lower extremity, below knee/above knee, custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code l5673 or l5679)
Category
COV
C
HCPCS
L5681
MULT_PI
A
PRICE1
38.00
RECID
3
SEQNUM
0010
SHORT DESCRIPTION
Intl custm cong/latyp insert
TOS1
P