CurrentUnitedHealthcarePolicy N/A

Reimbursement for orthotics and specialty shoes

Governs UnitedHealthcare Community Plan Medicaid reimbursement for orthotics, diabetic shoes, and orthopedic shoes billed on CMS-1500/UB04 forms; affects network and non-network physicians and other qualified health care professionals providing these services.

Policy Summary

PayerUnitedHealthcare Community Plan

PolicyReimbursement for orthotics and specialty shoes

Policy CodePolicy N/A

Change TypeNon‑material formatting and date/version updates

Effective DateN/A

Next Review DateN/A

Key ActionSubmit HCPCS procedure codes with corresponding ICD-10 diagnosis codes at the claim line level; ensure diabetic shoe codes are submitted with a diabetes diagnosis and orthopedic shoe codes are not.

SourceLink

POLICY UPDATE CHANGES

Converted table(s) to list(s) and added to Attachment Section

Policy Date and Version Change entries recorded on 4/20/2025 and prior dates

Medicaidprogram

2 listscode groups

Claim linebilling requirement

IN notedstate exception

Coverage and Billing Criteria

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Coverage and billing criteria

Reimbursement is contingent on submitting the correct HCPCS procedure codes with corresponding ICD-10 diagnosis codes at the claim line level; diabetic shoe codes must be billed with a diabetes diagnosis from the attachment and orthopedic shoe codes must not be billed with a diabetes diagnosis.

Reimbursement requires submission of the appropriate HCPCS procedure code together with a corresponding ICD-10 diagnosis code at the claim line level.

Claims for codes on the 'Diabetic Shoes' list must be billed with an ICD-10 diabetes diagnosis from the 'Diabetic Diagnosis' attachment.

See attachment: ICD-10 Diabetic Diagnosis Code List.

Claims for codes on the 'Orthopedic Shoes' list must NOT be billed with an ICD-10 diabetes diagnosis (use non-diabetes diagnosis codes as appropriate).

UnitedHealthcare Community Plan will not reimburse diabetic shoes or orthotics for members when a diabetes diagnosis is not reflected on the claim; likewise will not reimburse non-diabetic shoes or orthotics when a diabetes diagnosis is present on the claim.

State-specific billing exception: For Indiana, HCPCS code A5513 is subject to a maximum frequency/daily limit (see coding thresholds).

Code Lists and State Frequency Details

Diabetic ShoesHCPCSCovered

A5500	Diabetic Shoes HCPCS - A5500
A5501	Diabetic Shoes HCPCS - A5501
A5503	Diabetic Shoes HCPCS - A5503
A5504	Diabetic Shoes HCPCS - A5504
A5505	Diabetic Shoes HCPCS - A5505
A5506	Diabetic Shoes HCPCS - A5506
A5507	Diabetic Shoes HCPCS - A5507
A5508	Diabetic Shoes HCPCS - A5508
A5510	Diabetic Shoes HCPCS - A5510
A5512	Diabetic Shoes HCPCS - A5512

1–10 of 12

1/2

Orthopedic ShoesHCPCSCovered

L3201	Orthopedic Shoes HCPCS - L3201
L3202	Orthopedic Shoes HCPCS - L3202
L3203	Orthopedic Shoes HCPCS - L3203
L3204	Orthopedic Shoes HCPCS - L3204
L3206	Orthopedic Shoes HCPCS - L3206
L3207	Orthopedic Shoes HCPCS - L3207
L3215	Orthopedic Shoes HCPCS - L3215
L3216	Orthopedic Shoes HCPCS - L3216
L3217	Orthopedic Shoes HCPCS - L3217
L3219	Orthopedic Shoes HCPCS - L3219

1–10 of 21

1/3

Indiana MFD for A5513

StateIndiana (IN)

HCPCS codeA5513

Maximum frequency/detail (MFD)MFD of 2 per day

ScopeState-specific exception applies to claims submitted for Indiana Medicaid members

Claim Submission Requirements and Provider Responsibilities

Billing Rule

Claim submission requirements — HCPCS with ICD‑10 at claim line; diabetic shoe billing rules

Submit each HCPCS procedure code with the corresponding ICD‑10 diagnosis code at the claim line level. Diabetic shoe HCPCS codes must be billed with a diabetes diagnosis from the Diabetes Diagnosis attachment; orthopedic shoe HCPCS codes must not be billed with a diabetes diagnosis. UnitedHealthcare Community Plan will not reimburse diabetic shoes or orthotics if a diabetes diagnosis is not reflected on the claim, and will not reimburse non‑diabetic shoes or orthotics if a diabetes diagnosis is present on the claim.

Report ICD‑10 diagnosis codes at the claim line level for each HCPCS procedure code to be considered for reimbursement. [Q&A clarification]
Diabetic shoe HCPCS codes: submit with a diabetes diagnosis from the Diabetes Diagnosis attachment.
Orthopedic shoe HCPCS codes: do not submit with a diabetes diagnosis on the claim.
Claims lacking the required diagnosis-coding pairing will not be reimbursed.

Definitions — Product Types

Diabetic shoes — definition

TermDiabetic shoes

DefinitionSpecialty shoes billed with specific diabetic shoe HCPCS codes and submitted with a diabetes ICD-10 diagnosis from the Diabetes Diagnosis attachment.

Billing requirementDiabetic shoe HCPCS codes must be billed with a diabetes diagnosis on the claim to be reimbursed.

Applicable formsCMS-1500 and, when specified, UB04

Orthopedic shoes — definition

TermOrthopedic shoes

DefinitionFootwear identified by HCPCS orthopedic shoe codes (L32xx–L32xx series) used to provide orthopedic support; billed using the orthopedics HCPCS list and not to be submitted with a diabetes diagnosis.

Coding examplesSee HCPCS codes list (e.g., L3201, L3202, L3203, L3204, L3206, L3207, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3257, L3265)

Billing requirementOrthopedic shoe HCPCS codes should not be billed with a diabetes diagnosis on the claim.