How To Use HCPCS Code A5507

HCPCS code A5507 describes the modification (including fitting) of off-the-shelf depth-inlay shoes or custom-molded shoes for diabetics. This code is specifically for diabetics and is not otherwise specified. It falls under the category of diabetic shoes and is used to identify the service provided by healthcare providers for modifying and fitting these types of shoes.

1. What is HCPCS A5507?

HCPCS code A5507 is used to identify the modification (including fitting) of off-the-shelf depth-inlay shoes or custom-molded shoes for diabetics. This code is specific to diabetics and is not otherwise specified. It is important to note that this code is only applicable for the modification and fitting of diabetic shoes and should not be used for any other purpose.

2. Official Description

The official description of HCPCS code A5507 is “For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe.” The short description for this code is “Modification diabetic shoe.”

3. Procedure

1. The healthcare provider begins by assessing the patient’s foot condition and determining the need for modification of the shoe.
2. If the patient requires an off-the-shelf depth-inlay shoe, the provider selects the appropriate shoe size and style.
3. The provider then modifies the shoe according to the patient’s specific needs. This may involve adding or removing certain components, such as insoles or inserts, to accommodate the patient’s foot condition.
4. If the patient requires a custom-molded shoe, the provider takes measurements and creates a mold of the patient’s foot.
5. The provider then uses the mold to create a custom-molded shoe that fits the patient’s foot perfectly.
6. Once the modification or custom-molding is complete, the provider fits the shoe on the patient’s foot to ensure proper fit and comfort.

4. When to use HCPCS code A5507

HCPCS code A5507 should be used when a healthcare provider is modifying (including fitting) off-the-shelf depth-inlay shoes or custom-molded shoes specifically for diabetics. This code is not otherwise specified, meaning it is not limited to a particular type of modification or fitting. It is important to ensure that the patient meets the eligibility criteria for diabetic shoes and that the modification is necessary for their specific foot condition.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A5507, healthcare providers need to document the following:

• The patient’s diagnosis of diabetes
• The specific foot condition that requires modification of the shoe
• The type of modification performed (including any components added or removed)
• The type of shoe used (off-the-shelf depth-inlay or custom-molded)
• The number of shoes modified

It is important to provide detailed documentation to support the medical necessity of the modification and fitting of diabetic shoes.

6. Historical Information and Code Maintenance

HCPCS code A5507 was added to the Healthcare Common Procedure Coding System on January 01, 1995. It has an effective date of January 01, 2005. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code A5507 is covered by Medicare. The pricing indicator code for this code is 38, which indicates that it falls under the category of orthotics, prosthetics, prosthetic devices, and vision services. The pricing for this code is subject to floors and ceilings. The multiple pricing indicator code is A, which means it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of when HCPCS code A5507 should be billed:

1. A diabetic patient with a foot ulcer requires modification of their off-the-shelf depth-inlay shoe to accommodate the wound dressing.
2. A diabetic patient with neuropathy needs a custom-molded shoe to provide proper support and prevent foot ulcers.
3. A diabetic patient with a foot deformity requires modification of their off-the-shelf depth-inlay shoe to alleviate pressure on certain areas of the foot.
4. A diabetic patient with a history of foot infections needs a custom-molded shoe to reduce the risk of future infections.
5. A diabetic patient with peripheral artery disease requires modification of their off-the-shelf depth-inlay shoe to improve blood circulation in the feet.