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**Coding Structure Shoes - The service documentation required would depend on the level of service provided.
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**
Documentation: Statement of Certifying Physician Form, medical notes documenting eligibility for depth shoes and custom molded inserts, Authorization of Payment and Proof of delivery as well as the Vendor's invoice for shoes.
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**
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.