DFEC Durable Medical Equipment (DME) Rental and Purchase Limitations

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DFEC Durable Medical Equipment (DME) Rental and Purchase Limitations
PROCEDURE CODE	DESCRIPTION	Utilization Limitations	Utilization Effective Date	Rental/Purchase
A4595	TENS SUPPL 2 LEAD PER MONTH	1 per year	4/20/2020	Purchase
E0100	CANE ADJUST/FIXED WITH TIP	1 per year	5/13/2023	Purchase
E0105	CANE ADJUST/FIXED QUAD/3 PRO	1 per year	5/13/2023	Purchase
E0110	CRUTCH FOREARM PAIR	1 per year	5/13/2023	Purchase
E0112	CRUTCH UNDERARM PAIR WOOD	1 per year	5/13/2023	Purchase
E0114	CRUTCH UNDERARM PAIR NO WOOD	1 per year	5/13/2023	Purchase
E0130	WALKER RIGID ADJUST/FIXED HT	1 per 5 years	8/9/2025	Purchase
E0135	WALKER FOLDING ADJUST/FIXED	1 per 5 years	8/9/2025	Purchase
E0140	WALKER W TRUNK SUPPORT	1 per 5 years	8/9/2025	Purchase
E0141	RIGID WHEELED WALKER ADJ/FIX	1 per 5 years	8/9/2025	Purchase
E0143	WALKER FOLDING WHEELED W/O S	1 per 5 years	8/9/2025	Purchase
E0144	ENCLOSED WALKER W REAR SEAT	1 per 5 years	8/9/2025	Purchase
E0147	WALKER VARIABLE WHEEL RESIST	1 per 5 years	8/9/2025	Purchase
E0148	HEAVYDUTY WALKER NO WHEELS	1 per 5 years	8/9/2025	Purchase
E0149	HEAVY DUTY WHEELED WALKER	1 per 5 years	8/9/2025	Purchase
E0156	WALKER SEAT ATTACHMENT	1 per 3 years	5/13/2023	Purchase
E0158	WALKER LEG EXTENDERS SET OF4	1 per 3 years	5/13/2023	Purchase
E0159	BRAKE FOR WHEELED WALKER	1 per 3 years	5/13/2023	Purchase
E0165	COMMODE CHAIR WITH DETACHARM	1 per 5 years	8/9/2025	Purchase
E0170	COMMODE CHAIR ELECTRIC	1 per 5 years	8/9/2025	Purchase
E0171	COMMODE CHAIR NON-ELECTRIC	1 per 5 years	8/9/2025	Purchase
E0181	PRESS PAD ALTERNATING W/ PUM	1 per 5 years	8/9/2025	Purchase
E0182	REPLACE PUMP, ALT PRESS PAD	1 per 5 years	8/9/2025	Purchase
E0183	FLOTATION PAD FOR WHEELCHAIR	1 per 5 years	8/9/2025	Purchase
E0184	DRY PRESSURE MATTRESS	1 per 5 years	8/9/2025	Purchase
E0185	GEL PRESSURE MATTRESS PAD	1 per 5 years	8/9/2025	Purchase
E0186	AIR PRESSURE MATTRESS	1 per 5 years	8/9/2025	Purchase
E0187	WATER PRESSURE MATTRESS	1 per 5 years	8/9/2025	Purchase
E0193	POWERED AIR FLOTATION BED	1 per 5 years	8/9/2025	Purchase
E0194	AIR FLUIDIZED BED	1 per 5 years	8/9/2025	Purchase
E0196	GEL PRESSURE MATTRESS	1 per 5 years	8/9/2025	Purchase
E0197	AIR PRESSURE PAD FOR MATTRES	1 per 5 years	8/9/2025	Purchase
E0198	WATER PRESSURE PAD FOR MATTR	1 per 5 years	8/9/2025	Purchase
E0235	PARAFFIN BATH UNIT PORTABLE	1 per 5 years	8/9/2025	Purchase
E0240	BATH/SHOWER CHAIR	1 per 5 years	8/9/2025	Purchase
E0245	TUB STOOL OR BENCH	1 per 5 years	8/9/2025	Purchase
E0247	TRANS BENCH W/WO COMM OPEN	1 per 5 years	8/9/2025	Purchase
E0248	HDTRANS BENCH W/WO COMM OPEN	1 per 5 years	8/9/2025	Purchase
E0250	HOSP BED FIXED HT W/ MATTRES	1 per 5 years	8/9/2025	Purchase
E0251	HOSP BED FIXD HT W/O MATTRES	1 per 5 years	8/9/2025	Purchase
E0255	HOSPITAL BED VAR HT W/ MATTR	1 per 5 years	8/9/2025	Purchase
E0256	HOSPITAL BED VAR HT W/O MATT	1 per 5 years	8/9/2025	Purchase
E0260	HOSP BED SEMI-ELECTR W/ MATT	1 per 5 years	8/9/2025	Purchase
E0261	HOSP BED SEMI-ELECTR W/O MAT	1 per 5 years	8/9/2025	Purchase
E0290	HOSP BED FX HT W/O RAILS W/M	1 per 5 years	8/9/2025	Purchase
E0291	HOSP BED FX HT W/O RAIL W/O	1 per 5 years	8/9/2025	Purchase
E0292	HOSP BED VAR HT W/O RAIL W/O	1 per 5 years	8/9/2025	Purchase
E0293	HOSP BED VAR HT W/O RAIL W/	1 per 5 years	8/9/2025	Purchase
E0294	HOSP BED SEMI-ELECT W/ MATTR	1 per 5 years	8/9/2025	Purchase
E0295	HOSP BED SEMI-ELECT W/O MATT	1 per 5 years	8/9/2025	Purchase
E0301	HD HOSP BED, 350-600 LBS	1 per 5 years	8/9/2025	Purchase
E0302	EX HD HOSP BED > 600 LBS	1 per 5 years	8/9/2025	Purchase
E0303	HOSP BED HVY DTY XTRA WIDE	1 per 5 years	8/9/2025	Purchase
E0304	HOSP BED XTRA HVY DTY X WIDE	1 per 5 years	8/9/2025	Purchase
E0305	Rails bed side half length	1 per 5 years	8/9/2025	Purchase
E0316	BED SAFETY ENCLOSURE	1 per 5 years	8/9/2025	Purchase
E0471	RAD W/BACKUP NON INV INTRFC	1 per 5 years	8/9/2025	Purchase
E0620	CAP BLD SKIN PIERCING LASER	1 per 5 years	8/9/2025	Purchase
E0621	PATIENT LIFT SLING OR SEAT	1 per year	5/13/2023	Purchase
E0625	PATIENT LIFT BATHROOM OR TOI	1 per 5 years	8/9/2025	Purchase
E0627	SEAT LIFT MECH, ELECTRIC ANY	1 per 5 years	8/9/2025	Purchase
E0629	SEAT LIFT MECH, NON-ELECTRIC	1 per 5 years	8/9/2025	Purchase
E0630	PATIENT LIFT HYDRAULIC	1 per 5 years	8/9/2025	Purchase
E0635	PATIENT LIFT ELECTRIC	1 per 5 years	8/9/2025	Purchase
E0636	PT SUPPORT & POSITIONING SYS	1 per 5 years	8/9/2025	Purchase
E0637	COMBINATION SIT TO STAND SYS	1 per 5 years	8/9/2025	Purchase
E0638	STANDING FRAME SYS	1 per 5 years	8/9/2025	Purchase
E0639	MOVEABLE PATIENT LIFT SYSTEM	1 per 5 years	8/9/2025	Purchase
E0640	FIXED PATIENT LIFT SYSTEM	1 per 5 years	8/9/2025	Purchase
E0641	MULTI-POSITION STND FRAM SYS	1 per 5 years	8/9/2025	Purchase
E0642	DYNAMIC STANDING FRAME	1 per 5 years	8/9/2025	Purchase
E0658	SEG PNEUM COMP 2 ARM CHEST	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E0670	SEG PNEUM INT LEGS/TRUNK	1 per lifetime	5/13/2023	Purchase
E0720	TENS TWO LEAD	1 per lifetime	5/13/2023	Purchase
E0730	TENS FOUR LEAD	1 per lifetime	5/13/2023	Purchase
E0731	CONDUCTIVE GARMENT FOR TENS/	1 per 3 years	5/13/2023	Purchase
E0740	NON-IMPLANT PELV FLR E-STIM	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E0748	ELEC OSTEOGEN STIM SPINAL	1 per lifetime	5/13/2023	Purchase
E0760	OSTEOGEN ULTRASOUND STIMLTOR	1 per lifetime	5/13/2023	Purchase
E0764	FUNCTIONAL NEUROMUSCULAR STIM	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E0849	CERVICAL PNEUM TRAC EQUIP	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E0855	CERVICAL TRACTION EQUIPMENT	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E0955	CUSHIONED HEADREST	1 per year	5/13/2023	Purchase
E0958	WHLCHR ATT- CONV 1 ARM DRIVE	1 per 5 years	8/9/2025	Purchase
E0968	WHEELCHAIR COMMODE SEAT	1 per 5 years	8/9/2025	Purchase
E0985	W/C SEAT LIFT MECHANISM	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E0986	MAN W/C PUSH-RIM POWR SYSTEM	1 per 5 years	8/9/2025	Purchase
E0988	LEVER-ACTIVATED WHEEL DRIVE	1 per 5 years	2/1/2026	Purchase/Used Equipment Purchase
E1002	PWR SEAT TILT	1 per 5 years	8/9/2025	Purchase
E1003	PWR SEAT RECLINE	1 per 5 years	8/9/2025	Purchase
E1004	PWR SEAT RECLINE MECH	1 per 5 years	8/9/2025	Purchase
E1005	PWR SEAT RECLINE PWR	1 per 5 years	8/9/2025	Purchase
E1006	PWR SEAT COMBO W/O SHEAR	1 per 5 years	8/9/2025	Purchase
E1007	PWR SEAT COMBO W/SHEAR	1 per 5 years	8/9/2025	Purchase
E1008	PWR SEAT COMBO PWR SHEAR	1 per 5 years	8/9/2025	Purchase
E1010	ADD PWR LEG ELEVATION	1 per 5 years	8/9/2025	Purchase
E1012	CTR MOUNT PWR ELEV LEG REST	1 per 5 years	8/9/2025	Purchase
E1020	RESIDUAL LIMB SUPPORT SYSTEM	2 per 5 years	5/13/2023	Purchase
E1028	W/C MANUAL SWINGAWAY	6 per year	5/13/2023	Purchase
E1029	W/C VENT TRAY FIXED	1 per 5 years	8/9/2025	Purchase
E1030	W/C VENT TRAY GIMBALED	1 per 5 years	8/9/2025	Purchase
E1035	PATIENT TRANSFER SYSTEM <300	1 per 5 years	8/9/2025	Purchase
E1036	PATIENT TRANSFER SYSTEM >300	1 per 5 years	8/9/2025	Purchase
E1038	TRANSPORT CHAIR PT WT<=300LB	1 per 5 years	8/9/2025	Purchase
E1039	TRANSPORT CHAIR PT WT >300LB	1 per 5 years	8/9/2025	Purchase
E1050	WHELCHR FXD FULL LENGTH ARMS	1 per 5 years	8/9/2025	Purchase
E1060	WHEELCHAIR DETACHABLE ARMS	1 per 5 years	8/9/2025	Purchase
E1070	WHEELCHAIR DETACHABLE FOOT R	1 per 5 years	8/9/2025	Purchase
E1083	HEMI-WHEELCHAIR FIXED ARMS	1 per 5 years	8/9/2025	Purchase
E1084	HEMI-WHEELCHAIR DETACHABLE A	1 per 5 years	8/9/2025	Purchase
E1085	HEMI-WHEELCHAIR FIXED ARMS	1 per 5 years	8/9/2025	Purchase
E1086	HEMI-WHEELCHAIR DETACHABLE A	1 per 5 years	8/9/2025	Purchase
E1087	WHEELCHAIR LIGHTWT FIXED ARM	1 per 5 years	8/9/2025	Purchase
E1088	WHEELCHAIR LIGHTWEIGHT DET A	1 per 5 years	8/9/2025	Purchase
E1089	WHEELCHAIR LIGHTWT FIXED ARM	1 per 5 years	8/9/2025	Purchase
E1090	WHEELCHAIR LIGHTWEIGHT DET A	1 per 5 years	8/9/2025	Purchase
E1092	WHEELCHAIR WIDE W/ LEG RESTS	1 per 5 years	8/9/2025	Purchase
E1093	WHEELCHAIR WIDE W/ FOOT REST	1 per 5 years	8/9/2025	Purchase
E1100	WHCHR S-RECL FXD ARM LEG RES	1 per 5 years	8/9/2025	Purchase
E1130	WHLCHR STAND FXD ARM FT REST	1 per 5 years	8/9/2025	Purchase
E1140	WHEELCHAIR STANDARD DETACH A	1 per 5 years	8/9/2025	Purchase
E1150	WHEELCHAIR STANDARD W/ LEG R	1 per 5 years	8/9/2025	Purchase
E1160	WHEELCHAIR FIXED ARMS	1 per 5 years	8/9/2025	Purchase
E1161	MANUAL ADULT WC W TILTINSPAC	1 per 5 years	8/9/2025	Purchase
E1170	WHLCHR AMPU FXD ARM LEG REST	1 per 5 years	8/9/2025	Purchase
E1171	WHEELCHAIR AMPUTEE W/O LEG R	1 per 5 years	8/9/2025	Purchase
E1172	WHEELCHAIR AMPUTEE DETACH AR	1 per 5 years	8/9/2025	Purchase
E1180	WHEELCHAIR AMPUTEE W/ FOOT R	1 per 5 years	8/9/2025	Purchase
E1190	WHEELCHAIR AMPUTEE W/ LEG RE	1 per 5 years	8/9/2025	Purchase
E1195	WHEELCHAIR AMPUTEE HEAVY DUT	1 per 5 years	8/9/2025	Purchase
E1200	WHEELCHAIR AMPUTEE FIXED ARM	1 per 5 years	8/9/2025	Purchase
E1221	WHEELCHAIR SPEC SIZE W FOOT	1 per 5 years	8/9/2025	Purchase
E1222	WHEELCHAIR SPEC SIZE W/ LEG	1 per 5 years	8/9/2025	Purchase
E1223	WHEELCHAIR SPEC SIZE W FOOT	1 per 5 years	8/9/2025	Purchase
E1224	WHEELCHAIR SPEC SIZE W/ LEG	1 per 5 years	8/9/2025	Purchase
E1225	MANUAL SEMI-RECLINING BACK	1 per 5 years	8/9/2025	Purchase
E1226	MANUAL FULLY RECLINING BACK	1 per 5 years	8/9/2025	Purchase
E1227	WHEELCHAIR SPEC SZ SPEC HT A	1 per 5 years	8/9/2025	Purchase
E1228	WHEELCHAIR SPEC SZ SPEC HT B	1 per 5 years	8/9/2025	Purchase
E1230	POWER OPERATED VEHICLE	1 per 5 years	8/9/2025	Purchase
E1240	WHCHR LITWT DET ARM LEG REST	1 per 5 years	8/9/2025	Purchase
E1250	WHEELCHAIR LIGHTWT FIXED ARM	1 per 5 years	8/9/2025	Purchase
E1260	WHEELCHAIR LIGHTWT FOOT REST	1 per 5 years	8/9/2025	Purchase
E1270	WHEELCHAIR LIGHTWEIGHT LEG R	1 per 5 years	8/9/2025	Purchase
E1280	WHCHR H-DUTY DET ARM LEG RES	1 per 5 years	8/9/2025	Purchase
E1285	WHEELCHAIR HEAVY DUTY FIXED	1 per 5 years	8/9/2025	Purchase
E1290	WHEELCHAIR HVY DUTY DETACH A	1 per 5 years	8/9/2025	Purchase
E1295	WHEELCHAIR HEAVY DUTY FIXED	1 per 5 years	8/9/2025	Purchase
E1800	ADJUST ELBOW EXT/FLEX DEVICE	1 per month	5/13/2023	Rental
E1801	SPS ELBOW DEVICE	1 per month	5/13/2023	Rental
E1802	ADJST FOREARM PRO/SUP DEVICE	1 per month	5/13/2023	Rental
E1805	ADJUST WRIST EXT/FLEX DEVICE	1 per month	5/13/2023	Rental
E1806	SPS WRIST DEVICE	1 per month	5/13/2023	Rental
E1810	ADJUST KNEE EXT/FLEX DEVICE	1 per month	5/13/2023	Rental
E1811	SPS KNEE DEVICE	1 per month	5/13/2023	Rental
E1812	KNEE EXT/FLEX W ACT RES CTRL	1 per month	5/13/2023	Rental
E1815	ADJUST ANKLE EXT/FLEX DEVICE	1 per month	5/13/2023	Rental
E1816	SPS ANKLE DEVICE	1 per month	5/13/2023	Rental
E1818	SPS FOREARM DEVICE	1 per month	5/13/2023	Rental
E1820	SOFT INTERFACE MATERIAL	1 per month	5/13/2023	Rental
E1821	REPLACEMENT INTERFACE SPSD	1 per month	5/13/2023	Rental
E1825	ADJUST FINGER EXT/FLEX DEVC	1 per month	5/13/2023	Rental
E1830	ADJUST TOE EXT/FLEX DEVICE	1 per month	5/13/2023	Rental
E1831	STATIC STR TOE DEV EXT/FLEX	1 per month	5/13/2023	Rental
E1840	ADJ SHOULDER EXT/FLEX DEVICE	1 per month	5/13/2023	Rental
E2102	ADJU CGM RECEIVER/MONITOR	1 per 3 years	5/13/2023	Purchase
E2378	PW ACTUATOR REPLACEMENT	1 per year	5/13/2023	Purchase
K0669	SEAT/BACK CUS NO	2 per year	8/9/2025	Purchase
K0800	POV GROUP 1 STD UP TO 300LBS	1 per 5 years	8/9/2025	Purchase
K0801	POV GROUP 1 HD 301-450 LBS	1 per 5 years	8/9/2025	Purchase
K0802	POV GROUP 1 VHD 451-600 LBS	1 per 5 years	8/9/2025	Purchase
K0806	POV GROUP 2 STD UP TO 300LBS	1 per 5 years	8/9/2025	Purchase
K0807	POV GROUP 2 HD 301-450 LBS	1 per 5 years	8/9/2025	Purchase
K0808	POV GROUP 2 VHD 451-600 LBS	1 per 5 years	8/9/2025	Purchase
K0812	POV, NOC	1 per 5 years	8/9/2025	Purchase
K0813	PWC GP 1 STD PORT SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0814	PWC GP 1 STD PORT CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0815	PWC GP 1 STD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0816	PWC GP 1 STD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0820	PWC GP 2 STD PORT SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0821	PWC GP 2 STD PORT CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0822	PWC GP 2 STD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0823	PWC GP 2 STD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0824	PWC GP 2 HD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0825	PWC GP 2 HD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0826	PWC GP 2 VHD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0827	PWC GP VHD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0828	PWC GP 2 XTRA HD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0829	PWC GP 2 XTRA HD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0830	PWC GP2 STD SEAT ELEVATE S/B	1 per 5 years	8/9/2025	Purchase
K0831	PWC GP2 STD SEAT ELEVATE CAP	1 per 5 years	8/9/2025	Purchase
K0835	PWC GP2 STD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0836	PWC GP2 STD SING POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0837	PWC GP 2 HD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0838	PWC GP 2 HD SING POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0839	PWC GP2 VHD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0840	PWC GP2 XHD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0841	PWC GP2 STD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0842	PWC GP2 STD MULT POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0843	PWC GP2 HD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0848	PWC GP 3 STD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0849	PWC GP 3 STD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0850	PWC GP 3 HD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0851	PWC GP 3 HD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0852	PWC GP 3 VHD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0854	PWC GP 3 XHD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0855	PWC GP 3 XHD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0856	PWC GP3 STD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0857	PWC GP3 STD SING POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0858	PWC GP3 HD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0859	PWC GP3 HD SING POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0860	PWC GP3 VHD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0861	PWC GP3 STD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0862	PWC GP3 HD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0863	PWC GP3 VHD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0864	PWC GP3 XHD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0868	PWC GP 4 STD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0869	PWC GP 4 STD CAP CHAIR	1 per 5 years	8/9/2025	Purchase
K0870	PWC GP 4 HD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0871	PWC GP 4 VHD SEAT/BACK	1 per 5 years	8/9/2025	Purchase
K0877	PWC GP4 STD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0878	PWC GP4 STD SING POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0879	PWC GP4 HD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0880	PWC GP4 VHD SING POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0884	PWC GP4 STD MULT POW OPT S/B	1 per 5 years	8/9/2025	Purchase
K0885	PWC GP4 STD MULT POW OPT CAP	1 per 5 years	8/9/2025	Purchase
K0886	PWC GP4 HD MULT POW S/B	1 per 5 years	8/9/2025	Purchase
K0898	PWC, NOC	1 per 5 years	8/9/2025	Purchase
K0899	PWC Mobil Dev NO	1 per 5 years	8/9/2025	Purchase
L0113	CRANIAL CERVICAL TORTICOLLIS	1 per 5 years	11/1/2025	Purchase
L0120	CERV FLEX N/ADJ FOAM PRE OTS	1 per 5 years	11/1/2025	Purchase
L0130	FLEX THERMOPLASTIC COLLAR MO	1 per 5 years	11/1/2025	Purchase
L0140	CERVICAL SEMI-RIGID ADJUSTAB	2 per year	10/26/2024	Purchase
L0150	CERV SEMI-RIG ADJ MOLDED CHN	1 per 5 years	11/1/2025	Purchase
L0160	CERV SR WIRE OCC/MAN PRE OTS	1 per 5 years	11/1/2025	Purchase
L0170	CERVICAL COLLAR MOLDED TO PT	1 per 5 years	11/1/2025	Purchase
L0172	CERV COL SR FOAM 2PC PRE OTS	1 per 5 years	11/1/2025	Purchase
L0174	CERV SR 2PC THOR EXT PRE OTS	1 per 5 years	11/1/2025	Purchase
L0180	CER POST COL OCC/MAN SUP ADJ	1 per 5 years	11/1/2025	Purchase
L0190	CERV COLLAR SUPP ADJ CERV BA	1 per 5 years	11/1/2025	Purchase
L0200	CERV COL SUPP ADJ BAR & THOR	1 per 5 years	11/1/2025	Purchase
L0220	THOR RIB BELT CUSTOM FABRICA	1 per 5 years	11/1/2025	Purchase
L0450	TLSO FLEX TRUNK/THOR PRE OTS	1 per 5 years	11/1/2025	Purchase
L0452	TLSO FLEX CUSTOM FAB THORACI	1 per 5 years	11/1/2025	Purchase
L0454	TLSO TRNK SJ-T9 PRE CST	1 per 5 years	11/1/2025	Purchase
L0455	TLSO FLEX TRNK SJ-T9 PRE OTS	1 per 5 years	11/1/2025	Purchase
L0456	TLSO FLEX TRNK SJ-SS PRE CST	1 per 5 years	11/1/2025	Purchase
L0457	TLSO FLEX TRNK SJ-SS PRE OTS	1 per 5 years	11/1/2025	Purchase
L0458	TLSO 2MOD SYMPHIS-XIPHO PRE	1 per 5 years	11/1/2025	Purchase
L0460	TLSO 2 SHL SYMPHYS-STERN CST	1 per 5 years	11/1/2025	Purchase
L0462	TLSO 3MOD SACRO-SCAP PRE	1 per 5 years	11/1/2025	Purchase
L0464	TLSO 4MOD SACRO-SCAP PRE	1 per 5 years	11/1/2025	Purchase
L0466	TLSO R FRAM SOFT ANT PRE CST	1 per 5 years	11/1/2025	Purchase
L0467	TLSO R FRAM SOFT PRE OTS	1 per 5 years	11/1/2025	Purchase
L0468	TLSO RIG FRAM PELVIC PRE CST	1 per 5 years	11/1/2025	Purchase
L0469	TLSO RIG FRAM PELVIC PRE OTS	1 per 5 years	11/1/2025	Purchase
L0470	TLSO RIGID FRAME PRE SUBCLAV	1 per 5 years	11/1/2025	Purchase
L0472	TLSO RIGID FRAME HYPEREX PRE	1 per 5 years	11/1/2025	Purchase
L0480	TLSO RIGID PLASTIC CUSTOM FA	1 per 5 years	11/1/2025	Purchase
L0482	TLSO RIGID LINED CUSTOM FAB	1 per 5 years	11/1/2025	Purchase
L0484	TLSO RIGID PLASTIC CUST FAB	1 per 5 years	11/1/2025	Purchase
L0486	TLSO RIGIDLINED CUST FAB TWO	1 per 5 years	11/1/2025	Purchase
L0488	TLSO RIGID LINED PRE-ONE PIE	1 per 5 years	11/1/2025	Purchase
L0490	TLSO RIGID PLASTIC PRE-ONE	1 per 5 years	11/1/2025	Purchase
L0491	TLSO 2 PIECE RIGID SHELL	1 per 5 years	11/1/2025	Purchase
L0492	TLSO 3 PIECE RIGID SHELL	1 per 5 years	11/1/2025	Purchase
L0621	SIO FLEX PELVIC/SACR PRE OTS	1 per 5 years	11/1/2025	Purchase
L0622	SIO FLEX PELVISACRAL CUSTOM	1 per 5 years	11/1/2025	Purchase
L0623	SIO RIG PNL PELV/SAC PRE OTS	1 per 5 years	11/1/2025	Purchase
L0624	SIO PANEL CUSTOM	1 per 5 years	11/1/2025	Purchase
L0625	LO FLEX L1-BELOW L5 PRE OTS	1 per 5 years	11/1/2025	Purchase
L0626	LO SAG RIG PNL STAYS PRE CST	1 per 5 years	11/1/2025	Purchase
L0627	LO SAG RI AN/POS PNL PRE CST	1 per 5 years	11/1/2025	Purchase
L0628	LSO FLEX NO RI STAYS PRE OTS	1 per 5 years	11/1/2025	Purchase
L0629	LSO FLEX W/RIGID STAYS CUST	1 per 5 years	11/1/2025	Purchase
L0630	LSO R POST PNL SJ-T9 PRE CST	1 per 5 years	11/1/2025	Purchase
L0631	LSO SAG R AN/POS PNL PRE CST	1 per 5 years	11/1/2025	Purchase
L0632	LSO SAG RIGID FRAME CUST	1 per 5 years	11/1/2025	Purchase
L0633	LSO SC R POS/LAT PNL PRE CST	1 per 5 years	11/1/2025	Purchase
L0634	LSO FLEXION CONTROL CUSTOM	1 per 5 years	11/1/2025	Purchase
L0635	LSO SAGIT RIGID PANEL PREFAB	1 per 5 years	11/1/2025	Purchase
L0636	LSO SAGITTAL RIGID PANEL CUS	1 per 5 years	11/1/2025	Purchase
L0637	LSO SC R ANT/POS PNL PRE CST	1 per 5 years	11/1/2025	Purchase
L0638	LSO SAG-CORONAL PANEL CUSTOM	1 per 5 years	11/1/2025	Purchase
L0639	LSO S/C SHELL/PANEL PREFAB	1 per 5 years	11/1/2025	Purchase
L0640	LSO S/C SHELL/PANEL CUSTOM	1 per 5 years	11/1/2025	Purchase
L0641	LO RIG POS PNL L1-L5 PRE OTS	1 per 5 years	11/1/2025	Purchase
L0642	LO SAG RI AN/POS PNL PRE OTS	1 per 5 years	11/1/2025	Purchase
L0643	LSO SAG CTR RIGI POS PRE OTS	1 per 5 years	11/1/2025	Purchase
L0648	LSO SAG R AN/POS PNL PRE OTS	1 per 5 years	11/1/2025	Purchase
L0649	LSO SC R POS/LAT PNL PRE OTS	1 per 5 years	11/1/2025	Purchase
L0650	LSO SC R ANT/POS PNL PRE OTS	1 per 5 years	11/1/2025	Purchase
L0651	LSO SAG-CO SHELL PNL PRE OTS	1 per 5 years	11/1/2025	Purchase
L0970	TLSO CORSET FRONT	1 per 5 years	11/1/2025	Purchase
L0972	LSO CORSET FRONT	1 per 5 years	11/1/2025	Purchase
L0974	TLSO FULL CORSET	1 per 5 years	11/1/2025	Purchase
L0976	LSO FULL CORSET	1 per 5 years	11/1/2025	Purchase
L0978	AXILLARY CRUTCH EXTENSION	2 per 5 years	11/1/2025	Purchase
L0980	PERONEAL STRAPS PAIR PRE OTS	1 per 5 years	11/1/2025	Purchase
L0982	STOCKING SUP GRIPS 4 PRE OTS	1 per 5 years	11/1/2025	Purchase
L0984	PROTECT BODY SOCK EA PRE OTS	1 per 5 years	11/1/2025	Purchase
L1810	KO ELASTIC WITH JOINTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1812	KO ELASTIC W/JOINTS PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1820	KO ELAS W/ CONDYLE PADS & JO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1821	KO ELAS W/ CONDYLE PADS OTF	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1830	KO IMMOB CANVAS LONG PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1831	KNEE ORTH POS LOCKING JOINT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1832	KO ADJ JNT POS R SUP PRE CST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1833	KO ADJ JNT POS R SUP PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1834	KO W/0 JOINT RIGID MOLDED TO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1836	KO RIGID W/O JOINTS PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1840	KO DEROT ANT CRUCIATE CUSTOM	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1843	KO SINGLE UPRIGHT PRE CST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1844	KO W/ADJ JT ROT CNTRL MOLDED	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1845	KO DOUBLE UPRIGHT PRE CST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1846	KO W ADJ FLEX/EXT ROTAT MOLD	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1847	KO DBL UPRIGHT W/AIR PRE CST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1848	KO DBL UPRIGHT W/AIR PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1850	KO SWEDISH TYPE PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1851	KO SINGLE UPRIGHT PREFAB OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1852	KO DOUBLE UPRIGHT PREFAB OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1860	KO SUPRACONDYLAR SOCKET MOLD	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1200	FURNSH INITIAL ORTHOSIS ONLY	1 per 5 years	11/1/2025	Purchase
L1210	LATERAL THORACIC EXTENSION	2 per 5 years	11/1/2025	Purchase
L1220	ANTERIOR THORACIC EXTENSION	1 per 5 years	11/1/2025	Purchase
L1230	MILWAUKEE TYPE SUPERSTRUCTUR	1 per 5 years	11/1/2025	Purchase
L1240	LUMBAR DEROTATION PAD	1 per 5 years	11/1/2025	Purchase
L1250	ANTERIOR ASIS PAD	2 per 5 years	11/1/2025	Purchase
L1260	ANTERIOR THORACIC DEROTATION	1 per 5 years	11/1/2025	Purchase
L1270	ABDOMINAL PAD	3 per 5 years	11/1/2025	Purchase
L1280	RIB GUSSET (ELASTIC) EACH	2 per 5 years	11/1/2025	Purchase
L1290	LATERAL TROCHANTERIC PAD	2 per 5 years	11/1/2025	Purchase
L1300	BODY JACKET MOLD TO PATIENT	1 per 5 years	11/1/2025	Purchase
L1652	HO BI THIGHCUFFS W SPRDR BAR	1 per 5 years	11/1/2025	Purchase
L1660	HO ABDUCTION STATIC PLASTIC	1 per 5 years	11/1/2025	Purchase
L1680	PELVIC & HIP CONTROL THIGH C	1 per 5 years	11/1/2025	Purchase
L1681	HO BILATERAL HIP ABDUCTION	1 per 5 years	11/1/2025	Purchase
L1685	POST-OP HIP ABDUCT CUSTOM FA	1 per 5 years	11/1/2025	Purchase
L1686	HO POST-OP HIP ABDUCTION	1 per 5 years	11/1/2025	Purchase
L1900	AFO SPRNG WIR DRSFLX CALF BD	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1902	AFO ANKLE GAUNTLET PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1904	AFO MOLDED ANKLE GAUNTLET	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1906	AFO MULTILIG ANK SUP PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1907	AFO SUPRAMALLEOLAR CUSTOM	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1910	AFO SING BAR CLASP ATTACH SH	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1920	AFO SING UPRIGHT W/ ADJUST S	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1930	AFO PLASTIC	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1932	AFO RIG ANT TIB PREFAB TCF/=	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1940	AFO MOLDED TO PATIENT PLASTI	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1945	AFO MOLDED PLAS RIG ANT TIB	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1950	AFO SPIRAL MOLDED TO PT PLAS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1951	AFO SPIRAL PREFABRICATED	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1960	AFO POS SOLID ANK PLASTIC MO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1970	AFO PLASTIC MOLDED W/ANKLE J	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1971	AFO W/ANKLE JOINT, PREFAB	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1980	AFO SING SOLID STIRRUP CALF	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L1990	AFO DOUB SOLID STIRRUP CALF	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2000	KAFO SING FRE STIRR THI/CALF	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2005	KAFO SNG/DBL MECHANICAL ACT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2006	KAFO CUSTOM FABRICATED, KNEE-ANKLE-FOOT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2010	KAFO SNG SOLID STIRRUP W/O J	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2020	KAFO DBL SOLID STIRRUP BAND/	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2030	KAFO DBL SOLID STIRRUP W/O J	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2034	KAFO PLA SIN UP W/WO K/A CUS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2036	KAFO PLAS DOUB FREE KNEE MOL	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2037	KAFO PLAS SING FREE KNEE MOL	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2038	KAFO W/O JOINT MULTI-AXIS AN	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2040	HKAFO TORSION BIL ROT STRAPS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2050	HKAFO TORSION CABLE HIP PELV	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2060	HKAFO TORSION BALL BEARING J	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2070	HKAFO TORSION UNILAT ROT STR	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2080	HKAFO UNILAT TORSION CABLE	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2090	HKAFO UNILAT TORSION BALL BR	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2106	AFO TIB FX CAST PLASTER MOLD	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2108	AFO TIB FX CAST MOLDED TO PT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2112	AFO TIBIAL FRACTURE SOFT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2114	AFO TIB FX SEMI-RIGID	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2116	AFO TIBIAL FRACTURE RIGID	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2126	KAFO FEM FX CAST THERMOPLAS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2128	KAFO FEM FX CAST MOLDED TO P	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2132	KAFO FEMORAL FX CAST SOFT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2134	KAFO FEM FX CAST SEMI-RIGID	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2136	KAFO FEMORAL FX CAST RIGID	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2180	PLAS SHOE INSERT W ANK JOINT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2182	DROP LOCK KNEE	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2184	LIMITED MOTION KNEE JOINT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2186	ADJ MOTION KNEE JNT LERMAN T	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2188	QUADRILATERAL BRIM	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2190	WAIST BELT	1 per 5 years	11/1/2025	Purchase
L2192	PELVIC BAND & BELT THIGH FLA	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2200	LIMITED ANKLE MOTION EA JNT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2210	DORSIFLEXION ASSIST EACH JOI	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2220	DORSI & PLANTAR FLEX ASS/RES	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2230	SPLIT FLAT CALIPER STIRR & P	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2232	ROCKER BOTTOM, CONTACT AFO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2240	ROUND CALIPER AND PLATE ATTA	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2250	FOOT PLATE MOLDED STIRRUP AT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2260	REINFORCED SOLID STIRRUP	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2265	LONG TONGUE STIRRUP	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2270	VARUS/VALGUS STRAP PADDED/LI	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2275	PLASTIC MOD LOW EXT PAD/LINE	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2280	MOLDED INNER BOOT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2300	ABDUCTION BAR JOINTED ADJUST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2310	ABDUCTION BAR-STRAIGHT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2320	NON-MOLDED LACER	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2330	LACER MOLDED TO PATIENT MODE	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2335	ANTERIOR SWING BAND	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2340	PRE-TIBIAL SHELL MOLDED TO P	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2350	PROSTHETIC TYPE SOCKET MOLDE	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2360	EXTENDED STEEL SHANK	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2370	PATTEN BOTTOM	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2375	TORSION ANK & HALF SOLID STI	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2380	TORSION STRAIGHT KNEE JOINT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2385	STRAIGHT KNEE JOINT HEAVY DU	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2387	ADD LE POLY KNEE CUSTOM KAFO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2390	OFFSET KNEE JOINT EACH	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2395	OFFSET KNEE JOINT HEAVY DUTY	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2397	SUSPENSION SLEEVE LOWER EXT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2405	KNEE JOINT DROP LOCK EA JNT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2415	KNEE JOINT CAM LOCK EACH JOI	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2425	KNEE DISC/DIAL LOCK/ADJ FLEX	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2430	KNEE JNT RATCHET LOCK EA JNT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2435	KNEE JOINT POLYCENTRIC JOINT	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2492	KNEE LIFT LOOP DROP LOCK RIN	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2500	THI/GLUT/ISCHIA WGT BEARING	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2510	TH/WGHT BEAR QUAD-LAT BRIM M	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2520	TH/WGHT BEAR QUAD-LAT BRIM C	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2525	TH/WGHT BEAR NAR M-L BRIM MO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2526	TH/WGHT BEAR NAR M-L BRIM CU	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2530	THIGH/WGHT BEAR LACER NON-MO	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2540	THIGH/WGHT BEAR LACER MOLDED	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2550	THIGH/WGHT BEAR HIGH ROLL CU	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2660	THORACIC CONTROL THORACIC BA	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2670	THORAC CONT PARASPINAL UPRIG	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L2680	THORAC CONT LAT SUPPORT UPRI	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L3000	FT INSERT UCB BERKELEY SHELL	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3001	FOOT INSERT REMOV MOLDED SPE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3002	FOOT INSERT PLASTAZOTE OR EQ	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3003	FOOT INSERT SILICONE GEL EAC	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3010	FOOT LONGITUDINAL ARCH SUPPO	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3020	FOOT LONGITUD/METATARSAL SUP	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3030	FOOT ARCH SUPPORT REMOV PREM	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3031	FOOT LAMIN/PREPREG COMPOSITE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3040	FT ARCH SUPRT PREMOLD LONGIT	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3050	FOOT ARCH SUPP PREMOLD METAT	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3060	FOOT ARCH SUPP LONGITUD/META	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3070	ARCH SUPRT ATT TO SHO LONGIT	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3080	ARCH SUPP ATT TO SHOE METATA	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3090	ARCH SUPP ATT TO SHOE LONG/M	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3100	HALLUS-VALGUS NT DYN PRE OTS	1 left per 2 years 1 right per 2 years	11/1/2025	Purchase
L3199	UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED	1 every 2 years left 1 every 2 years right	11/1/2025	Purchase
L3215	ORTHOPEDIC FTWEAR LADIES OXF	2 pair per 2 years	11/1/2025	Purchase
L3216	ORTHOPED LADIES SHOES DPTH I	2 pair per 2 years	11/1/2025	Purchase
L3217	LADIES SHOES HIGHTOP DEPTH I	2 pair per 2 years	11/1/2025	Purchase
L3219	ORTHOPEDIC MENS SHOES OXFORD	2 pair per 2 years	11/1/2025	Purchase
L3221	ORTHOPEDIC MENS SHOES DPTH I	2 pair per 2 years	11/1/2025	Purchase
L3222	MENS SHOES HIGHTOP DEPTH INL	2 pair per 2 years	11/1/2025	Purchase
L3251	SHOE MOLDED TO PT SILICONE S	2 pair per 2 years	11/1/2025	Purchase
L3252	SHOE MOLDED PLASTAZOTE CUST	2 pair per 2 years	11/1/2025	Purchase
L3253	SHOE MOLDED PLASTAZOTE CUST	2 pair per 2 years	11/1/2025	Purchase
L3254	ORTH FOOT NON-STNDARD SIZE/W	2 per 2 years	11/1/2025	Purchase
L3255	ORTH FOOT NON-STANDARD SIZE/	2 per 2 years	11/1/2025	Purchase
L3257	ORTH FOOT ADD CHARGE SPLIT S	2 per 2 years	11/1/2025	Purchase
L3300	SHO LIFT TAPER TO METATARSAL	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3310	SHOE LIFT ELEV HEEL/SOLE NEO	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3320	SHOE LIFT ELEV HEEL/SOLE COR	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3330	LIFTS ELEVATION METAL EXTENS	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3332	SHOE LIFTS TAPERED TO ONE-HA	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3334	SHOE LIFTS ELEVATION HEEL /I	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3340	SHOE WEDGE SACH	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3350	SHOE HEEL WEDGE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3360	SHOE SOLE WEDGE OUTSIDE SOLE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3370	SHOE SOLE WEDGE BETWEEN SOLE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3390	SHOE OUTFLARE WEDGE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3400	SHOE METATARSAL BAR WEDGE RO	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3410	SHOE METATARSAL BAR BETWEEN	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3420	FULL SOLE/HEEL WEDGE BTWEEN	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3430	SHO HEEL COUNT PLAST REINFOR	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3440	HEEL LEATHER REINFORCED	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3450	SHOE HEEL SACH CUSHION TYPE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3455	SHOE HEEL NEW LEATHER STANDA	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3460	SHOE HEEL NEW RUBBER STANDAR	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3465	SHOE HEEL THOMAS WITH WEDGE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3470	SHOE HEEL THOMAS EXTEND TO B	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3480	SHOE HEEL PAD & DEPRESS FOR	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3485	SHOE HEEL PAD REMOVABLE FOR	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3500	ORTHO SHOE ADD LEATHER INSOL	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3510	ORTHOPEDIC SHOE ADD RUB INSL	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3520	O SHOE ADD FELT W LEATH INSL	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3530	ORTHO SHOE ADD HALF SOLE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3540	ORTHO SHOE ADD FULL SOLE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3550	O SHOE ADD STANDARD TOE TAP	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3560	O SHOE ADD HORSESHOE TOE TAP	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3570	O SHOE ADD INSTEP EXTENSION	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3580	O SHOE ADD INSTEP VELCRO CLO	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3590	O SHOE CONVERT TO SOF COUNTE	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3595	ORTHO SHOE ADD MARCH BAR	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3600	TRANS SHOE CALIP PLATE EXIST	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3610	TRANS SHOE CALIPER PLATE NEW	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3620	TRANS SHOE SOLID STIRRUP EXI	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3630	TRANS SHOE SOLID STIRRUP NEW	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3640	SHOE DENNIS BROWNE SPLINT BO	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3649	ORTHOPEDIC SHOE MODIFICA NOS	2 left per 2 years 2 right per 2 years	11/1/2025	Purchase
L3650	SO 8 ABD RESTRAINT PRE OTS	1 per 5 years	11/1/2025	Purchase
L3660	SO 8 AB RSTR CAN/WEB PRE OTS	1 per 5 years	11/1/2025	Purchase
L3670	SO ACRO/CLAV CAN WEB PRE OTS	1 per 5 years	11/1/2025	Purchase
L3671	SO CAP DESIGN W/O JNTS CF	1 per 5 years	11/1/2025	Purchase
L3674	SO AIRPLANE W/WO JOINT CF	1 per 5 years	11/1/2025	Purchase
L3675	SO VEST CANVAS/WEB PRE OTS	1 per 5 years	11/1/2025	Purchase
L3677	SO HARD PLAS STABILI PRE CST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L3702	EO W/O JOINTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3710	EO ELAS W/METAL JNTS PRE OTS	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3720	FOREARM/ARM CUFFS FREE MOTIO	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3730	FOREARM/ARM CUFFS EXT/FLEX A	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3740	CUFFS ADJ LOCK W/ ACTIVE CON	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3760	EO ADJ JT PREFAB CUSTOM FIT	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3761	ELBOW, ADJ LOCK JOINT PREFAB OT	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3762	EO RIGID W/O JOINTS PRE OTS	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3763	EWHO RIGID W/O JNTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3764	EWHO W/JOINT(S) CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3765	EWHFO RIGID W/O JNTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3766	EWHFO W/JOINT(S) CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3806	WHFO W/JOINT(S) CUSTOM FAB	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3807	WHFO W/O JOINTS PRE CST	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3808	WHFO, RIGID W/O JOINTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3809	WHFO W/O JOINTS PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3900	HINGE EXTENSION/FLEX WRIST/F	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3901	HINGE EXT/FLEX WRIST FINGER	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3904	WHFO ELECTRIC CUSTOM FITTED	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3905	WHO W/NONTORSION JNT(S) CF	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3906	WHO W/O JOINTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3908	WHO COCK-UP NONMOLDE PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3912	HFO FLEXION GLOVE PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3913	HFO W/O JOINTS CF	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3915	WHO NONTORSION JNTS PRE CST	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3916	WHO NONTORSION JNTS PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3917	METACARP FX ORTHOSIS PRE CST	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3918	METACARP FX ORTHOSIS PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3919	HO W/O JOINTS CF	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3921	HFO W/JOINT(S) CF	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3923	HFO WITHOUT JOINTS PRE CST	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3924	HFO WITHOUT JOINTS PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3925	FO PIP DIP JNT/SPRNG PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3927	FO PIP DIP NO JT SPR PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3929	HFO NONTORSION JNTS PRE CST	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3930	HFO NONTORSION JNTS PRE OTS	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3931	WHFO NONTORSION JOINT PREFAB	1 left per 5 years; 1 right per 5 years	11/1/2025	Purchase
L3960	SEWHO AIRPLAN DESIG ABDU POS	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3961	SEWHO CAP DESIGN W/O JNTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3962	SEWHO ERBS PALSEY DESIGN ABD	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3967	SEWHO AIRPLANE W/O JNTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3971	SEWHO CAP DESIGN W/JNT(S) CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3973	SEWHO AIRPLANE W/JNT(S) CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3975	SEWHFO CAP DESIGN W/O JNT CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3976	SEWHFO AIRPLANE W/O JNTS CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3977	SEWHFO CAP DESGN W/JNT(S) CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3978	SEWHFO AIRPLANE W/JNT(S) CF	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3980	UP EXT FX ORTHOS HUMERAL NOS	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L3984	UPPER EXT FX ORTHOSIS WRIST	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L4350	ANKLE CONTROL ORTHO PRE OTS	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L4360	PNEUMAT WALKING BOOT PRE CST	1 left per 5 years 1 right per 5 years	11/1/2025	Purchase
L4361	PNEUMA/VAC WALK BOOT PRE OTS	1 left per 5 years 1 right per 5 years	11/1/2025	Purchase
L4370	PNEUM FULL LEG SPLNT PRE OTS	1 per 5 years L; 1 per 5 years R	11/1/2025	Purchase
L4386	NON-PNEUM WALK BOOT PRE CST	1 left per 5 years 1 right per 5 years	11/1/2025	Purchase
L4387	NON-PNEUM WALK BOOT PRE OTS	1 left per 5 years 1 right per 5 years	11/1/2025	Purchase
L4396	STATIC OR DYNAMI AFO PRE CST	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L4397	STATIC OR DYNAMI AFO PRE OTS	1 left per 5 years 1 right per 5 years	11/1/2025	Purchase
L4398	FOOT DROP SPLINT PRE OTS	1 per 5 years left; 1 per 5 years right	11/1/2025	Purchase
L4631	AFO, WALK BOOT TYPE, CUS FAB	1 left per 5 years 1 right per 5 years	11/1/2025	Purchase
L8001	BREAST PROSTHESIS BRA & FORM	1 per 6 months left; 1 per 6 months right	11/1/2025	Purchase
L8002	BRST PRSTH BRA & BILAT FORM	1 per 6 months left; 1 per 6 months right	11/1/2025	Purchase
L8015	EXT BREASTPROSTHESIS GARMENT	1 per 6 months left; 1 per 6 months right	11/1/2025	Purchase
L8020	MASTECTOMY FORM	1 per 6 months left; 1 per 6 months right	11/1/2025	Purchase
L8030	BREAST PROSTHES W/O ADHESIVE	1 every 2 years left 1 every 2 years right	11/1/2025	Purchase
L8031	BREAST PROSTHESIS W ADHESIVE	1 every 2 years left 1 every 2 years right	11/1/2025	Purchase
L8032	REUSABLE NIPPLE PROSTHESIS	1 every 3 months left 1 every 3 months right	11/1/2025	Purchase