Podiatry Coding & Billing Alert

Question: We are currently billing A5500 and A5513 for shoes for diabetic Medicare patients. Are these correct?

Illinois Subscriber

Answer: Codes 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) and 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) correctly apply to footwear prescribed for diabetic Medicare patients. Codes for diabetic shoes have very different descriptions, however, so you should check the specifications of the shoes to make sure that they match codes you report.

Check this out: You'll use A5500 for an adjustable depth shoe that:

• has a full length, heel-to-toe filler that when removed provides a minimum of 3/16" of additional depth used to accommodate custom-molded or customized inserts

• is made from leather or other suitable material of equal quality

• has some form of shoe closure, such as laces or Velcro I

• is available in full and half sizes with a minimum of three widths to assure a proper fit.

For example: Advance Orthopedic and Comfort Footwear qualifies for reimbursement under this definition.

Take note: A5513 is for shoes with the following specifications:

• for diabetics only

• has multiple density insert that is custom molded from model of patient's foot and has total contact with patient's foot, including archbase layer minimum of 3/16" material of Shore A 35 durometer or higher,

• includes arch filler and other shaping material

• is custom fabricated.

There are several more codes specifically for therapeutic footwear suitable for diabetics, with varying specifications, so you should thoroughly read all the code descriptors before choosing a code.