The Healthcare Common Procedure Coding System (HCPCS) is a standardized coding system used by Medicare, Medicaid, and private commercial insurance in the United States to identify medical products and services for reimbursement purposes.
I. Overview: Diabetic Footwear & Insole Coding
HCPCS provides specific codes for medically necessary footwear designed for diabetic patients. These products are primarily categorized under A-Codes (Medical Supplies) and L-Codes (Orthotic Procedures/Devices).
II. Diabetic Footwear Codes (Custom & Off-the-Shelf)
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A5500 – For Custom Molded Shoes
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Description: Diabetic shoe, extra-depth, custom molded from a patient-specific cast.
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Key Features: Custom-molded for maximum foot protection, providing an extra-depth cavity to accommodate swelling or orthopedic inserts.
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A5501 – For Off-the-Shelf Depth Shoes
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Description: Diabetic shoe, extra-depth, off-the-shelf.
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Key Features: Prefabricated (non-custom) depth-inlay shoes that meet structural requirements for diabetic foot care.
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A5503 – For Custom-Made Extra-Depth Shoes
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Description: Diabetic shoe, extra-depth, custom-made.
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Key Features: Fully customized footwear designed for patients with complex foot deformities requiring specific adjustments.
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A5504 – For Off-the-Shelf Extra-Depth Shoes
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Description: Diabetic shoe, extra-depth, prefabricated (off-the-shelf).
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Key Features: Standardized extra-depth shoes designed to reduce pressure without full customization.
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III. Diabetic Insole Codes (The Core of Aybroad’s Expertise)
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A5512 – Custom-Molded Accommodative Inserts (Top Priority)
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Description: For diabetics only, multiple density insert, custom molded, and/or accommodative.
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Key Features: High-performance accommodative inserts designed to cushion, support, and protect the diabetic foot by redistributing pressure.
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A5513 – Prefabricated, Heat-Molded Inserts
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Description: For diabetics only, multiple density insert, prefabricated, molded to patient’s foot using heat.
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Key Features: Prefabricated bases that are heat-adjusted or modified for a semi-custom fit.
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A5514 – Off-the-Shelf Prefabricated Inserts
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Description: For diabetics only, multiple density insert, prefabricated, off-the-shelf.
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Key Features: Non-molded, ready-to-wear inserts providing basic cushioning and protection.
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IV. Specialized Orthotic & Replacement Codes
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A5515 – Replacement Inserts
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Description: Diabetic insole, additional coverage, replacement for custom insoles.
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Key Features: Used for replacing worn-out or expired custom diabetic inserts.
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L3030 – Custom-Molded Inserts (Removable)
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Description: Insole, custom-molded, removable, for use with diabetic footwear.
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Key Features: High-specification custom molded inserts categorized under the L-series orthotic code.
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L3031 – Prefabricated Diabetic Inserts
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Description: Insole, prefabricated, for use with diabetic shoes.
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Key Features: Ready-to-use inserts designed to lower plantar pressure and improve patient comfort.
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