Coding Structure - Medicare has a coding structure for shoes, shoe modifications, diabetic inserts and toe fillers. The service documentation required would depend on the level of service provided. Please find the area of interest and click on the link for detailed information.

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• Shoes - A5500 and A5501
• Shoe Modifications - A5503, A5504, A5505, A5506, A5507 and A5508
• Diabetic Inserts - A5510, A5512 and A5513
• Shoe Toe Fillers - L5000

Shoes - A5500 and A5501

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.

 

Shoe Modifications - A5503, A5504, A5505, A5507 and A5508

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.

 

Diabetic Inserts A5510, A5512, A5513

Coding Structure Inserts

Medicare instituted a coding structure for diabetic inserts as of April 1, 2004. Coverage is determined by the fabrication method and the achievement of total contact. The service documentation required would depend on the level of service provided (A5510, A5512 and A5513).

A5510

For diabetics only, direct formed, compression molded to patient's foot without external heatsource, 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**

Documentation: None required, this fabrication technique is a non-covered service and will deny payment.

A5512

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

Documentation: Vendor’s invoice for an insert capable of achieving total contact via external heating and direct molding to the foot. Medical notes documenting the direct molding technique utilized to achieve and verify total contact with the plantar surface of the foot. The practitioner is responsible for documenting the achievement of total contact to qualify for coverage.

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.

Documentation: The orthotic laboratory invoice for a custom molded total contact device.

Shoe Toe Fillers - L5000

Coding Structure Toe Fillers

The service documentation required would depend on the level of service provided (A5500).

A5500

Partial foot, shoe insert with longitudinal arch, toe filler **inserts for missing toes or partial foot amputation**

Documentation: Vendor's invoice for a toe filler that meets Medicare guidelines.