Coding Guidelines for Therapeutic Shoes for Persons with Diabetes

This article is being published to reemphasize a policy that has been in place since the initiation of Coding Verification Reviews of Therapeutic Shoes and Inserts.

A5500 and A5501 include two components to the codes.  The first component is the fitting and follow-up associated with dispensing the shoes. The second is the composition and characteristic components of the shoe.

When a manufacturer and/or distributor submits their therapeutic shoes to the Pricing, Data Analysis, and Coding Contractor (PDAC) for coding verification review, that review is solely focused on whether the composition and characteristic components of the shoe meets the requirements specified in the Coding Guidelines section of the Therapeutic Shoes for Persons with Diabetes Policy Article.  Inclusion of a shoe on the Product Classification List does not indicate whether the fitting and follow-up is acceptable. That determination is made by the Durable Medical Equipment Medicare Administrative Contractor (DME MAC), and other contractors that conduct medical review of claims.

Suppliers are reminded to access the Durable Medical Equipment Coding System (DMECS) at https://www.dmepdac.com/dmecs/index.html, or contact the PDAC Contact Center at 877-735-1326, for any questions regarding the correct coding of products.