Coding Structure Shoe Modifications - The service documentation required would depend on the level of service provided.
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.
Documentation: Statement of Certifying Physician Form, medical notes documenting eligibility for depth shoes or custom molded shoes, Authorization of Payment and Proof of delivery as well as the Vendor's invoice for shoes.
A5504 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe.
Documentation: Statement of Certifying Physician Form, medical notes documenting eligibility for depth shoes, Authorization of Payment and Proof of delivery as well as the Vendor's invoice for shoes.
A5505 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe.
Documentation: Statement of Certifying Physician Form, medical notes documenting eligibility for depth shoes, Authorization of Payment and Proof of delivery as well as the Vendor's invoice for shoes.