HCPCS Code - Diabetic Footwear A5500-A5514 - Codify by AAPC (2024)

FAQs

What is Medicare HCPCS code A5500 diabetic shoe? ›

An A5500 shoe is an off-the-shelf shoe manufactured to accommodate particular needs for diabetics and that has met all the specifications to qualify for reimbursem*nt through Medicare and other health insurances providers. The “A5500” is a standardized code used by these entities for healthcare claims.

HCPCS code A5514 for For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes ...

HCPCS code G0245 for Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) which must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a ...

Diabetic Footwear HCPCS Code range A5500-A5514.

Coverage is for anyone with Medicare Part B who has diabetes, documentation from a qualified doctor, and: Diabetic Neuropathy, poor blood circulation, a history of ulcers, a history of pre-ulcerative calluses, foot deformities, previous amputation of the foot or part of either foot.

Shoes for patients living with diabetes are made of special protective inserts and soft shoe materials to accommodate for conditions, such as neuropathy (numb feet), poor circulation and foot deformities (bunions, hammertoes, etc.).

While these definitions may be a bit wordy or confusing, the main difference relates to the model that the orthotics are manufactured from – physical model (A5513) vs digital, CAD-CAM model (A5514).

Deluxe features must be coded using code A5508.

A: The items and services described by HCPCS codes A5512 (inserts molded to the patient's foot) and A5513 (inserts molded to a model of the patient's foot) are different types of therapeutic shoe inserts. Both use different, specific processes for molding or customizing the multiple density insert for the patient.

Type 2 diabetes mellitus with foot ulcer

E11. 621 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursem*nt purposes.

How to bill a diabetic foot exam? ›

The Centers for Medicare and Medicaid Services (CMS) considers G0245 to be an E/M code, and the Correct Coding Initiatives edits consider G0245 to be a component of E/M, which means that reimbursem*nt for G0245 is included in the office visit code (99201–99215) reimbursem*nt when both the exam and the visit are billed ...

The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold). American Diabetes Association (ADA).

HCPCS code A5500 for For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi- density insert(s), per shoe as maintained by CMS falls under Diabetic Footwear .

Diabetic Shoes are considered durable medical equipment (DME) and require a prescription from your provider. You can call your insurance provider and ask about your benefits for diabetic shoes. Alternatively, our patient care coordinator Beata can help you out with a complimentary benefits check.

Therapeutic shoes for diabetics are not DME and are not considered DME nor orthotics, but a separate category of coverage under Medicare Part B.

A depth shoe (A5500) is one that: Has a full length, heel-to-toe filler that when removed provides a minimum of 3/16" of additional depth used to accommodate custom-molded or customized inserts; and.

Part B (Medical Insurance)

covers the furnishing and fitting of either of these each calendar year, if you have diabetes and severe diabetes-related foot disease: One pair of custom-molded shoes and inserts. One pair of extra-depth shoes.

HCPCS Code for Orthopedic footwear, custom shoe, depth inlay, each L3230.