Prefabricated Inserts - "An insert (A5512) is a total contact, multiple density, prefabricated removable inlay that isdirectly molded to the patient's foot. Direct molded means it has been conformed by molding directly to match the plantar surface of the individual patient's foot."
"The insert must retain its shape during use for the life of the insert. The layer responsible for shape retention is called the "base layer" in the code descriptor. This material usually constitutes the bottom layer of the insert and must be of a sufficient thickness and durometer to maintain its shape during use (i.e. 1/4 inch of 35 Shore A or 3/16 inch of 40 Shore A). The material responsible for maintaining the shape of the insert must be heat moldable. The full thickness of the base layer should extend from the heel through the arch. The base layer may taper beginning at the metatarsals and may be absent at the toes."
"The top layer(s) of the insert must also be heat moldable and are usually lower durometer. Modifications such as additional arch fill may be necessary to achieve and maintain total contact. The materials used should be suitable with regards to the patient's condition."
Practitioners must use an accepted molding technique to qualify for coverage. Heating the insert, placing iit in the shoe and having the patient stand on the insert is the same as compression molding. This technique does not adequately capture the shape of the plantar surface nor does it achieve total contact. Medicare has stated that compression molding is a non-covered service. Medicare has issued specific instructions and photographs of a molding techniques that qualify for coverage.