RETIRED - Diabetic Shoe Insert - A5510 Noncovered


Content Provided on this page contains outdated information and instruction and should not be considered current. Noridian is providing this archived information for research purposes only. This archived article contains previously issued instructions that have since been updated or are no longer applicable for Medicare billing purposes.

This article is retired effective February 1, 2018. Current direction on correct coding as well as revised information about the Coding Verification Review project process are included in the article titled: Correct Coding – Inserts Used with Therapeutic Shoes for Persons with Diabetes (A5512, A5513, K0903), published February 1, 2018.

Original Effective Date: 03/15/2002
Revision Effective Date: 11/01/2013

An article in the Winter 2002 (January) Region D DMERC Dialogue announced the establishment of three new codes for diabetic inserts – A5509, A5510, and A5511 – which were effective for dates of service on or after January 1, 2002 and replaced code A5502. The Centers for Medicare & Medicaid Services (CMS) has determined that inserts that are not heat-molded to the patient's foot at the time of dispensing do not meet the requirements of the statutory benefit for coverage of therapeutic shoes and inserts for diabetics. Therefore, code A5510 (for diabetics only, direct formed, compression molded to foot without external heat source, multiple density insert(s), prefabricated, per shoe) will be denied as noncovered effective for dates of service on or after January 1, 2002.

Last Updated Dec 11 , 2023