Summary & Overview
HCPCS A5500: Diabetic Off-the-Shelf Depth-Inlay Shoe, Custom Supply and Fitting
HCPCS Level II code A5500 covers the custom preparation and supply of an off-the-shelf depth-inlay shoe designed to accommodate multi-density inserts, intended for patients with diabetes and billed per shoe. This code is significant because diabetic therapeutic footwear can reduce foot complications, including ulceration and amputation risk, making coverage and correct billing important for access to preventive care nationally. Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what this code represents clinically, where the service is typically delivered, and what to expect in terms of billing context and payer considerations. The publication provides benchmarks and policy-relevant context for utilization and coverage, summarizes payer approaches and eligibility considerations, and highlights clinical circumstances that commonly support use of the code. Data not available in the input where specific utilization metrics, associated taxonomies, ICD-10 pairings, and related codes would normally appear.
Billing Code Overview
HCPCS Level II code A5500 describes the custom preparation and supply of an off-the-shelf depth-inlay shoe manufactured to accommodate multi-density inserts, provided for patients with diabetes only. The code includes the fitting (including follow-up) and is reported per shoe.
Service Type: Custom diabetic therapeutic footwear supply and fitting
Typical Site of Service: Outpatient specialty clinics, prosthetics/orthotics shops, or retail medical supply locations where diabetic footwear is dispensed and fitted
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with long-standing type 2 diabetes mellitus presents to a podiatry or orthotics clinic with neuropathic foot pain, plantar ulceration risk, and structural forefoot deformity. The treating clinician documents diabetic peripheral neuropathy, previous callus formation, and a history of slow-healing plantar ulcer on the first metatarsal head. After an evaluation that includes gait assessment and foot measurements, the clinician determines the patient requires therapeutic depth-inlay shoes fitted to accommodate multi-density removable inserts. The workflow includes an initial evaluation and fitting visit, custom modification of an off-the-shelf depth-inlay shoe to accept multi-density inserts, production/supply of the modified shoes (per shoe), and at least one documented follow-up fitting to assess fit and make minor adjustments. Typical sites of service are outpatient specialty clinics such as podiatry offices, orthotics and prosthetics facilities, or ambulatory care centers. Payer interactions include verifying diabetic eligibility for the benefit, documenting medical necessity (e.g., neuropathy with callus or previous ulcer), and applying the appropriate HCPCS Level II code A5500 per shoe for billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | When billing for the left shoe when laterality is reported separately |