| 
| L5000 |  | Partial foot, shoe insert with longitudinal arch, toe filler 
| short | Sho insert w arch toe filler |  | MUE | | Location | Value | Ajudication Indicator | Rationale | 
|---|
 | PRA | 0.0 | 3 Date of Service Edit: Clinical | CMS Policy |  | OPH | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration |  | DME | 2.0 | 3 Date of Service Edit: Clinical | Anatomic Consideration | 
 |  |  | 
| 
| L5010 |  | Partial foot, molded socket, ankle height, with toe filler 
| short | Mold socket ank hgt w/ toe f |  | 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 | 
 |  |  | 
| 
| L5020 |  | Partial foot, molded socket, tibial tubercle height, with toe filler 
| short | Tibial tubercle hgt w/ toe f |  | 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 | 
 |  |  |