## **What is HCPCS code A5500?**
A5500 HCPCS refers to the fitting (including follow-up), custom preparation, and supply of an off-the-shelf depth inlay shoe manufactured specifically as therapeutic shoes for diabetics.
The shoe is designed to accommodate multi-density insert or other suitable material and is billed per shoe. It is primarily used for diabetic patients to help manage the beneficiary’s systemic diabetes condition, such as diabetic neuropathy, poor circulation, pre-ulcerative calluses, or foot deformities. The shoe may also be prescribed for patients with previous amputation or those requiring heel to toe filler or customized inserts.
This code falls under medical and surgical supplies, diabetic shoes and footwear category, with moderate complexity in service level and corresponding reimbursement rates.
## **HCPCS code A5500 documentation requirements**
HCPCS code A5500 documentation requirements for billing diabetic therapeutic shoes should be comprehensive and critical for Medicare compliance. Documentation must include:
- A detailed written order from the treating physician.
- A completed, signed, and dated certification from the certifying physician managing the beneficiary’s systemic diabetes condition, confirming diabetes diagnosis and at least one qualifying condition such as previous amputation, foot ulceration history, pre-ulcerative calluses, diabetic neuropathy, foot deformity, or poor circulation.
- Clinical evaluation by the certifying physician within 6 months before delivery, addressing diabetes management.
- Relevant clinical records documenting the diabetic condition and qualifying criteria, either personally documented by the certifying physician or obtained from another clinician.
- Records from a supplier-conducted in-person visit and foot evaluation before item selection, detailing abnormalities requiring accommodation of custom fabricated or custom molded footwear.
- Records of an in-person visit at the time of shoe delivery assessing the fit with the beneficiary wearing the shoes.
- Any applicable Advance Beneficiary Notice (ABN).
Failure to provide these documents upon Medicare's request can lead to claim denial.
## **HCPCS Code A5500 billing requirements**
Billing requirements include:
- Shoes must be available in full and half sizes, ensuring equal quality for the patient’s foot and the other foot.
- Claims must be billed using this specific HCPCS code with proper coding guidelines and documentation.
- Compliance with Medicare policies, including custom fabricated inserts or custom molded components if required.
- Note that exact reimbursement amounts can vary by region and year; and it is best to confirm with current Medicare fee schedules.
- Suppliers must adhere to Medicare policies to avoid claim denials and referrals for non-compliance with documentation requests.
## **Other relevant codes**
Relevant HCPCS codes related to A5500, which all pertain to diabetic footwear and related inserts/modifications, include:
- **A5501**: Similar to A5500 but for custom-molded depth shoes for diabetics.
The entire range A5500 to A5514 includes diabetic footwear and their accompanying therapeutic inserts/modifications to support patients with diabetes and foot complications.
Frequently asked questions
