Coding: Browse HCPCS Level II 2020 Edition

Browse HCPCS Level II 2020 Edition

A5500 - A5514 Diabetic Shoes, Fitting, and Modifications

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

short

Diab shoe for density insert

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Published Contractor Policy

A5501

For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe

short

Diabetic custom molded shoe

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Published Contractor Policy

A5503

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe

short

Diabetic shoe w/roller/rockr

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Published Contractor Policy

A5504

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe

short

Diabetic shoe with wedge

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Published Contractor Policy

A5505

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe

short

Diab shoe w/metatarsal bar

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Published Contractor Policy

A5506

For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe

short

Diabetic shoe w/off set heel

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	2 Date of Service Edit: Policy	Published Contractor Policy

A5507

For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

short

Modification diabetic shoe

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	2.0	3 Date of Service Edit: Clinical	Published Contractor Policy

A5508

For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

short

Diabetic deluxe shoe

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

A5510

For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe

short

Compression form shoe insert

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Ajudication Indicator	Rationale
PRA	3 Date of Service Edit: Clinical	CMS Policy
OPH	3 Date of Service Edit: Clinical	CMS Policy
DME	3 Date of Service Edit: Clinical	Published Contractor Policy

A5512

For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each

short

Multi den insert direct form

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	6.0	2 Date of Service Edit: Policy	CMS Policy

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

short

Multi den insert custom mold

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	6.0	2 Date of Service Edit: Policy	CMS Policy

A5514

For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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

short

Mult den insert dir carv/cam

RVU

CPT Modifier	Physician Component	Facility Practice	Nonfacility Practice	Professional Liability Insurance	Total Facility	Total Nonfacility	Global Period
	0.0	0.0	0.0	0.0	0.0	0.0	XXX

MUE

Location	Value	Ajudication Indicator	Rationale
PRA	0.0	3 Date of Service Edit: Clinical	CMS Policy
OPH	0.0	3 Date of Service Edit: Clinical	CMS Policy
DME	6.0	2 Date of Service Edit: Policy	CMS Policy