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L1700 |
 |
Legg perthes orthosis, (toronto type), custom fabricated
| short | Leg perthes orth toronto typ |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L1710 |
|
Legg perthes orthosis, (newington type), custom fabricated
| short | Legg perthes orth newington |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L1720 |
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Legg perthes orthosis, trilateral, (tachdijan type), custom fabricated
| short | Legg perthes orthosis trilat |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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L1730 |
|
Legg perthes orthosis, (scottish rite type), custom fabricated
| short | Legg perthes orth scottish r |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment | | DME | 1.0 | 2 Date of Service Edit: Policy | Nature of Equipment |
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L1755 |
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Legg perthes orthosis, (patten bottom type), custom fabricated
| short | Legg perthes patten bottom t |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy | | OPH | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration | | DME | 2.0 | 2 Date of Service Edit: Policy | Anatomic Consideration |
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