Summary & Overview
HCPCS A5505: Diabetic Shoe Modification with Metatarsal Bar
HCPCS Level II code A5505 denotes the modification and fitting of an off-the-shelf depth-inlay shoe or a custom-molded shoe that includes a metatarsal bar, restricted to patients with diabetes and billed per shoe. This code matters nationally because therapeutic footwear and related modifications are a key element of diabetic foot care aimed at preventing ulcers and complications that drive downstream costs and morbidity. Major national payers commonly referenced in coverage discussions include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what A5505 represents clinically and operationally, which payers typically cover similar services, and what to expect in terms of service setting and documentation needs. The publication provides benchmarks and policy context relevant to billing and coverage of therapeutic shoe modifications, highlights common payer approaches to diabetic footwear, and outlines the clinical circumstances that make this service relevant. Data not available in the input is noted where applicable; this summary focuses on the code definition, service type, and payer landscape at a national level.
Billing Code Overview
HCPCS Level II code A5505 describes a modification, including fitting, of an off-the-shelf depth-inlay shoe or a custom-molded shoe that includes a metatarsal bar, and it applies for patients with diabetes only, billed per shoe. The service type is prosthetic/orthotic footwear modification and fitting. The typical site of service is outpatient durable medical equipment (DME) or prosthetics/orthotics clinics and other outpatient settings where therapeutic footwear and shoe modifications are provided.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with long-standing type 2 diabetes mellitus and peripheral neuropathy presents to a podiatry or orthotics clinic for evaluation of chronic forefoot pain and recurrent callus formation over the metatarsal heads. After assessment, the clinician determines the patient would benefit from a depth-inlay or custom-molded therapeutic shoe with a metatarsal bar to offload plantar pressure and reduce ulceration risk. The workflow includes an initial evaluation by a podiatrist or orthotist, measurement and casting or fitting of an off-the-shelf depth-inlay or custom-molded shoe, fabrication or modification to add a metatarsal bar, a fitting visit to adjust alignment and comfort, and follow-up visits to monitor skin integrity and fit. Billing uses HCPCS Level II code A5505 for the modification (including fitting) of an off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, billed per shoe. Documentation includes diabetes diagnosis, neuropathy or history of foot ulceration, foot measurements/cast, description of the modification performed, date of fitting, and patient education on shoe use and skin monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side | Use when the modification is for the left shoe only |