Coding redetermination for custom diabetic inserts announced

A publication released in July by the Medicare administrative contractor for durable medical equipment, which clarified the use of billing code A5513 for custom diabetic inserts, has spurred a coding redetermination that will end all previous A5513 verifications by the end of May 2018, according to a press release from the American Orthotic and Prosthetic Association (AOPA).

The Medicare administrative contractor for durable medical equipment issued a publication stating that in order to meet the descriptor requirements of Healthcare Common Procedure Coding System (HCPCS) code A5513, custom diabetic inserts must be molded over an actual model of the patient’s foot. The use of electronic, or “virtual” models, without a physical model, does not meet this requirement, the publication reported.

In response, the Pricing, Data Analysis and Coding Contractor (PDAC) on Aug. 10 announced it would begin a coding redetermination project for diabetic inserts that fall under A5513. According to AOPA, the project will end all previous A5513 PDAC coding verifications effective May 31, 2018.

Manufacturers and central fabrication facilities seeking PDAC verification for A5513 will be required to submit a new application to the contractor, AOPA reported. This applies to both new and existing products previously verified by the PDAC.

The PDAC said all verification applications should be submitted “well in advance” of the May 31, 2018 ending date. Products currently verified by the contractor for A5513 can continue to be billed using the code until May 31, 2018. Medicare claims for diabetic inserts, as described by A5513, with a date of service on or after June 1, 2018, will need a new PDAC coding verification, according to AOPA.

The full PDAC statement can be viewed here:

“As a reminder, AOPA members who are fabricating diabetic inserts described by A5513 for use by their own patients are not required to obtain PDAC verification but must meet the requirements of the code descriptor which includes the creation of a positive model of the patient’s foot,” read the AOPA press release.


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