Medicare HCPCS Code
It is our determination that the Medicare HCPCS code to bill the four DME Medicare Administrative Contractors (DME MACs) is:
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 PATIENET'S FOOT, INCLUDING ARCH, BASE LAYER MINIMM OF ¼ INCH MATERIAL OF SHORE A 35 DUROMETER OR 3/16 INCH MATERIAL OF SHORE A 40 DUROMETER (OR HIGHER), PREFABRICATED, EACH
Orthotic Billing Codes
|97760||Orthotic Management and Training
"assessment and fitting" - 15 minute units
|97762||Checkout for Orthotic
"established patient" - 15 minute units
|L3030||Orthotic - Foot, insert, removable, formed to patient's foot, custom modified, each - heat moldable|
|L3060||Orthotic - Foot, insert, removable, formed to patient's foot, not custom modified, each - non heat moldable|
For diabetics only, multiple density insert, direct formed, molded tofoot 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.
Applicable to the Vasyli – Armstrong Sensitive feet Orthotics
The above mentioned coding is a suggestion and does not guarantee reimbursement from a 3rd party provider. Please check with patient's provider for reimbursement guidelines.