| A6502 | Compression burn garment, chin strap, custom fabricated |
| A6507 | Compression burn garment, foot to knee length, custom fabricated |
| A6504 | Compression burn garment, glove to wrist, custom fabricated |
| A6505 | Compression burn garment, glove to elbow, custom fabricated |
| A6506 | Compression burn garment, glove to axilla, custom fabricated |
| L0220 | Thoracic, rib belt, custom fabricated |
| L1834 | Knee orthosis, without knee joint, rigid, custom fabricated |
| A6510 | Compression burn garment, trunk, including arms down to leg openings (leotard), custom fabricated |
| L1907 | Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated |
| A6503 | Compression burn garment, facial hood, custom fabricated |
| L4055 | Replace non-molded calf lacer, for custom fabricated orthosis only |
| A6513 | Compression burn mask, face and/or neck, plastic or equal, custom fabricated |
| E2609 | Custom fabricated wheelchair seat cushion, any size |
