HCPCS Level II A5501: Custom Molded Diabetic Shoe, Per Shoe

HCPCS Level II code A5501 describes the fitting (including follow-up), custom preparation and supply of a shoe molded from cast(s) of a diabetic patient’s foot, billed per shoe; service type is custom orthopedic shoe fabrication and fitting, and the typical site of service is an outpatient durable medical equipment or prosthetics/orthotics setting such as a specialty shoe clinic or orthopedic supplier.

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HCPCS Level II A5501: Custom Molded Diabetic Shoe, Per Shoe

Customize your policy alerts

Sign up for hcpcs A5501 policy alerts

Get alerted when payer policies referencing A5501 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old person with long-standing type 2 diabetes mellitus and peripheral neuropathy who presents to a podiatry or orthotics clinic for evaluation of foot deformity and risk of ulceration. The patient has a history of callus formation beneath the metatarsal heads and a prior plantar ulcer on the same foot that healed. The clinician performs a focused lower-extremity examination, documents neuropathy, vascular status, skin integrity, and footwear assessment, and determines the need for a custom-molded diabetic therapeutic shoe.

The clinical workflow includes: initial assessment by a podiatrist or orthotist; casting of the patients foot(s) using a foam or plaster cast to capture anatomy; submission of the cast and prescription to a shoe laboratory; fitting visit when the custom-molded shoe (A5501) is received; any required adjustments and a documented follow-up fit evaluation; and documentation of medical necessity (diabetes diagnosis with neuropathy or prior ulceration) in the medical record. Typical site of service is an outpatient clinic, podiatry office, orthotics/prosthetics facility, or specialty shoe fitting center. The service is furnished only for patients with diabetes and is billed per shoe when custom molded from casts of the patients foot.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for the evaluation and documentation of diabetic foot risk and medical necessity prior to ordering `A5501`
`29540`	Casting, foot; for orthotic device, also may include taking impression	Performed when a practitioner or orthotist takes a foot cast prior to fabrication of a custom molded shoe
`97760`	Orthotic(s) management and training, initial encounter	Used when providing training and fitting for therapeutic footwear and patient education
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	May be used for additional supplies or materials related to fitting if allowed by payer
`97035`	Ultrasound therapy, each 15 minutes (example adjunct code)	Occasionally used for adjunctive therapies in ulcer care before/after footwear intervention

Related Modifiers

5 rows

Modifier	Description	When to Use
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
81	Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…	- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
235Z00000X	Speech-Language Pathologist	The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
2251N0400X	Neurology Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Neurologic Physical Therapy, who has …
342000000X	Transportation Network Company	A ride-sharing company that provides prearranged or contracted non-emergency medical transportation services to patients through mobile or online tech…
207NP0225X	Pediatric Dermatology Physician	A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emph…
2086X0206X	Surgical Oncology Physician	A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevent…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
E10.51	Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52	Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.42	Type 2 diabetes mellitus with diabetic polyneuropathy
E11.51	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.621	Type 2 diabetes mellitus with foot ulcer
E11.628	Type 2 diabetes mellitus with other skin complications
E66.9	Obesity, unspecified
E78.5	Hyperlipidemia, unspecified

Showing 1–10 of 26

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for the evaluation and documentation of diabetic foot risk and medical necessity prior to ordering `A5501`
`29540`	Casting, foot; for orthotic device, also may include taking impression	Performed when a practitioner or orthotist takes a foot cast prior to fabrication of a custom molded shoe
`97760`	Orthotic(s) management and training, initial encounter	Used when providing training and fitting for therapeutic footwear and patient education
`99070`	Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit	May be used for additional supplies or materials related to fitting if allowed by payer
`97035`	Ultrasound therapy, each 15 minutes (example adjunct code)	Occasionally used for adjunctive therapies in ulcer care before/after footwear intervention

Related Modifiers

5 rows

Modifier	Description	When to Use
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
81	Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…	- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
235Z00000X	Speech-Language Pathologist	The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207L00000X	Anesthesiology Physician	An anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
333600000X	Pharmacy	A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative servi…
2251N0400X	Neurology Physical Therapist	A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Neurologic Physical Therapy, who has …
342000000X	Transportation Network Company	A ride-sharing company that provides prearranged or contracted non-emergency medical transportation services to patients through mobile or online tech…
207NP0225X	Pediatric Dermatology Physician	A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emph…
2086X0206X	Surgical Oncology Physician	A surgical oncologist is a well-qualified surgeon who has obtained additional training and experience in the multidisciplinary approach to the prevent…

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
E10.51	Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E10.52	Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.42	Type 2 diabetes mellitus with diabetic polyneuropathy
E11.51	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene
E11.52	Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.621	Type 2 diabetes mellitus with foot ulcer
E11.628	Type 2 diabetes mellitus with other skin complications
E66.9	Obesity, unspecified
E78.5	Hyperlipidemia, unspecified

Showing 1–10 of 26

Related Codes

HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

HCPCS Level II A4210: Needle-free Injection Device, Each

HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

HCPCS Level II A4211: Supplies for Self-Administered Injections

HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

HCPCS Level II A4215: Needle, Sterile, Any Size

HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

Showing 1–10 of 633

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II A5501: Custom Molded Diabetic Shoe, Per Shoe

Sign up for hcpcs A5501 policy alerts

HCPCS Level II A5501: Custom Molded Diabetic Shoe, Per Shoe

Sign up for hcpcs A5501 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code A5501 cover and where is it typically provided?

What clinical indications or documentation support billing A5501?

Is A5501 billed per patient or per shoe, and what are the typical steps in the service workflow?

Which related codes are commonly used with A5501 during the assessment and fitting process?

Which payers are listed as covering A5501 and does the page provide reimbursement rates?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What does HCPCS code A5501 cover and where is it typically provided?

What clinical indications or documentation support billing A5501?

Is A5501 billed per patient or per shoe, and what are the typical steps in the service workflow?

Which related codes are commonly used with A5501 during the assessment and fitting process?

Which payers are listed as covering A5501 and does the page provide reimbursement rates?

References