Billing 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.
K0628 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 ¼ inch material of shore a 35
durometer, or 3/16 inch material of shore a
40 durometer (or higher), prefabricated,
each.
Diabetic shoes, inserts and/or modifications
are covered if the following criteria are
met:
1) Patients who have diabetes mellitus
(ICD-9-CM diagnosis code 250.00-250.91) and:
2) This patient has one or more of the
following conditions:
- History of partial or complete
amputation of the foot.
- History of previous foot ulceration.
- History of pre-ulcerative callus.
- Peripheral Neuropathy with evidence
of callus formation.
- Foot deformity.
- Poor circulation.
3) The certifying physician, who is managing
the patient's systemic diabetes condition
has certified that indications (1) and (2)
are met and that he/she is treating the
patient under a comprehensive plan of care
for his/her diabetes and that the patient
needs diabetic shoes. The certifying
physician must be an M.D. or D.O.
This policy requires that the certifying
physician, providing the medical care for
the diabetic condition must sign a statement
that the conditions stated above are met.
The prescribing physician may be a
podiatrist, M.D. or D.O. and should write
the order for the therapeutic shoes,
modifications, and inserts.
The supplier, the person or entity
furnishing the shoes, modifications, or
inserts may be a podiatrist, pedorthist,
orthotist, prosthetist, or other qualified
individual. The supplier should bill
Medicare for the service.
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Diabetic Footware
