1. One (1) pair of depth shoes (A5500).
2. Three (3) pairs of inserts (A5512 or A5513).
These do not include the non-customized
removable inserts provided with such shoes.
OR
1. One (1) pair of custom molded shoes (A5501).
This includes inserts provided with these shoes.
2. Two (2) additional pairs of inserts (A5512 or A5513)

The patient’s benefits are renewed on January 1st of each year.
If shoes and/or inserts are dispensed in less than a year from the
last dispensing, a reason for the early dispensing should be
noted in the patient’s chart.

The reimbursement for shoes and inserts is a global payment
and includes the footwear evaluation, fitting and follow-up
sessions. If unrelated evaluation and management or medical
services are performed during the same visit they can be billed
to the local Medicare carrier.

NEW 2005 National Maximum Allowables
A5500 – Diabetic Depth Shoes (per pair) $118.72
A5501 – Diabetic Molded shoes (per pair) $356.08
A5512 – Diabetic Inserts, Direct Molded (per pair) $48.44
A5510 – Diabetic Inserts, Compression Molded NON-COVERED
A5513 – Diabetic Inserts, Custom Fabricated (per pair) $72.28
L5000 – Diabetic Inserts, With Toe Filler (each) $405.20 to $540.27
depending on the state.

Toe Filler Reimbursement
Toe fillers are covered as a Medicare reimbursable item.
Considered a prosthetic device, the filler is billed using the L5000
code. The prosthetic device consists of the toe filler and the insert it
is attached to, therefore, replacing the need for a separate insert for
the affected foot. Contact the SureFit Medicare Resource Center for
details on the billing of toe fillers.

Billing Options
Claims for Medicare Durable Medical Equipment items are submitted
to your regional DME Carrier. If the patient’s main address listed with
Medicare is within another region then the claim must be submitted
to that region. Claims can be submitted paper based or
electronically. SureFit maintains an in-house electronic
billing service exclusively for its clients. For those wishing
to bill their own claims, a SureFit billing specialist will assist
your staff with the initial setup.