HCPCS Code A5513: Custom Molded Multiple Density Inserts for Diabetic Patients

Medicare typically covers up to three pairs of inserts (six individual inserts) per calendar year for each eligible beneficiary when all documentation requirements are met. Anything beyond this limit requires additional justification of medical necessity.

No. A5513 exclusively requires a custom-molded insert fabricated from a physical positive model of the patient’s foot. Inserts made solely by CAD-CAM or digitized scanning, without a physical model, must be billed as A5514. Billing CAD-CAM inserts under A5513 is considered incorrect and may lead to claim denial or recoupment.

If an insert is not PDAC-verified for A5513, it must be billed under A9270 (non-covered item/service). Submitting it as A5513 without PDAC verification is considered incorrect coding and may result in claim denial or overpayment recovery.