Podiatry Coding & Billing Alert

Answer: UnitedHealthcare’s Diabetic and Other Orthopedic Shoes policy (policy number 2022R7105A, found at www. uhcprovider.com/content/dam/provider/docs/public/policies/ medicaid-comm-plan-reimbursement/UHCCP-Diabetic-Other- Orthopedic-Shoes-Policy-(R7105).pdf) has been updated several times recently, but the only significant policy change was an update to the ICD-10-CM diabetic codes in 2020.

The reimbursement guidelines in their current form tell you UnitedHealthcare “will not reimburse for diabetic shoes or orthotics provided to patients without a diagnosis of diabetes reflected on the claim.” But it also goes on to say they “will not reimburse for non-diabetic shoes or orthotics to patients with a diagnosis of diabetes reflected on the submitted claim, as there are more appropriate codes that should be utilized.”

In other words, they derived their policy “by identifying correct coding between HCPCS and ICD-10” according to their guidelines. What that means is you should submit a diabetes code from the list provided at www.uhcprovider.com/content/ dam/provider/docs/public/policies/attachments/reimbursement/ ICD-10_Diabetic_Diagnosis_Code_List.pdf that correlates with the HCPCS Level II diabetic footwear codes A5500-A5514 (For diabetics only …). The policy also tells you not to submit orthopedic shoe, surgical boot, benesch boot, and other orthopedic footwear claims reported with HCPCS Level II codes L3201-L3265 with one of the diabetes codes on the same list.

You should note that the diabetes codes on UnitedHealthcare’s list are all E08 (Diabetes mellitus due to underlying condition) codes. This means you cannot submit A5500-A5514 diabetic footwear claims for patients with type 1 or type 2 diabetes, coded to E10.- and E11.-. Footwear claims for these patients must be for orthopedic footwear coded to L3201-L3265.