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Billing Codes

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 PATIENT'S FOOT, INCLUDING ARCH, BASE LAYER MINIMUM OF ΒΌ 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
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.

Applicable to the VASYLI + Armstrong II Sensitive feet Orthotics