Podiatry Coding & Billing Alert

Question: Are A5500 and A5513 the right codes to bill for shoes for diabetic Medicare patients?

Virginia Subscriber

Answer: You are correct. Codes A5500 (For diabetics only, fitting [including follow-up], custom preparation and supply of offthe- shelf depth-inlay shoe manufactured to accommodate multidensity 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) apply to footwear prescribed for diabetic Medicare patients.

Catch: Codes for diabetic shoes have very different descriptions, however, so you should thoroughly read all the code descriptors before choosing a code. For instance, 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.

Meanwhile, 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.