Therapeutic Shoes and Inserts For
Diabetics Procedure Coding

Shoes
A5500 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
**Off-the-shelf depth shoes like those supplied by SureFit**
A5501 For diabetics only, fitting (including follow-up), custom
preparation and supply of shoe molded from cast(s) of patient's
foot (custom molded shoe), per shoe
** Custom molded shoes. Not supplied by SureFit**

Shoe Modifications
A5503 For diabetics only, modification (including fitting) of
off-the-shelf depth-inlay shoe or custom-molded shoe with
roller or rigid rocker bottom, per shoe
A5504 For diabetics only, modification (including fitting) of off-the-shelf
depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
A5505 For diabetics only, modification (including fitting) of off-the-shelf
depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe
A5506 For diabetics only, modification (including fitting) of off-the-shelf
depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe
A5507 For diabetics only, not otherwise specified modification (including
fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5508 For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe
or custom-molded shoe, per shoe

Inserts
A5512 For diabetics only, multiple density insert, direct formed, molded to
foot after external heat source of 230 degrees Fahrenheit or higher, total
contact with patient's foot, including arch, base layer minimum of 1/4
inch material of shore a 35 durometer or 3/16 inch material of shore a
40 (or higher), prefabricated, each

A5510 For diabetics only, direct formed, compression molded to patient's
foot without external heat source, multiple-density insert(s), prefabricated,
per shoe. **Placing a prefabricated insert in a patient’s shoe and
permitting the heat and pressure of the foot to compression mold the
device – NON-COVERED SERVICE**

A5513 For diabetics only, multiple density insert, custom molded from
model of patient's foot, total contact with patient's foot, including arch,
base layer minimum of 3/16 inch material of shore a 35 durometer or
higher, includes arch filler and other shaping material, custom
fabricated, each

Toe Filler
L5000 Partial foot, shoe insert with longitudinal arch, toe filler
**Inserts for missing toes or partial foot amputation**

Code Modifiers
KX Specific required documentation on file
LT Left side
RT Right side