How To Use HCPCS Code A5512

HCPCS code A5512 describes a specific type of multiple density insert that is used for diabetics. This insert is directly formed and molded to the patient’s foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. It provides total contact with the patient’s foot, including the arch, and has specific requirements for the base layer material. This code is prefabricated and is used to identify this particular type of insert.

1. What is HCPCS A5512?

HCPCS code A5512 is used to identify a multiple density insert that is specifically designed for diabetics. This insert is formed by molding it directly to the patient’s foot after it has been exposed to an external heat source of 230 degrees Fahrenheit or higher. It provides total contact with the patient’s foot, including the arch, and has specific requirements for the base layer material. This code is prefabricated and is used to accurately identify and bill for this particular type of insert.

2. Official Description

The official description of HCPCS code A5512 is as follows: “For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each.” The short description for this code is “Multi den insert direct form.”

3. Procedure

1. The provider begins by selecting a multiple density insert that meets the requirements outlined in HCPCS code A5512.
2. The insert is then heated to a temperature of 230 degrees Fahrenheit or higher using an external heat source.
3. Once the insert has reached the appropriate temperature, it is carefully molded to the patient’s foot, ensuring total contact with the foot, including the arch.
4. The base layer of the insert must be made of a minimum of 1/4 inch material with a shore a 35 durometer or 3/16 inch material with a shore a 40 durometer or higher.
5. After the insert has been molded to the patient’s foot, it is considered ready for use.

4. When to use HCPCS code A5512

HCPCS code A5512 should be used when providing a multiple density insert that meets the specific requirements outlined in the code. This code is only applicable for diabetics and should not be used for individuals without diabetes. It is important to ensure that the insert is directly formed and molded to the patient’s foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. Additionally, the insert must provide total contact with the patient’s foot, including the arch, and have the specified base layer material.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A5512, healthcare providers must ensure that the documentation supports the use of this specific code. The medical record should clearly indicate that the patient is diabetic and requires a multiple density insert. Additionally, documentation should show that the insert was directly formed and molded to the patient’s foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. It should also specify that the insert provides total contact with the patient’s foot, including the arch, and meets the requirements for the base layer material.

6. Historical Information and Code Maintenance

HCPCS code A5512 was added to the Healthcare Common Procedure Coding System on January 01, 2006. As of the effective date of January 01, 2019, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. This code has remained unchanged since its addition to the system.

7. Medicare and Insurance Coverage

HCPCS code A5512 is covered by Medicare and other insurance providers. 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 multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS priced under one methodology. Healthcare providers should consult the Medicare Carriers Manual Reference Section Number 2134 for specific guidelines on billing and coverage for this code.

8. Examples

Here are five examples of when HCPCS code A5512 should be billed:

1. A diabetic patient requires a multiple density insert that is directly formed and molded to their foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. The insert provides total contact with the patient’s foot, including the arch, and meets the requirements for the base layer material.
2. A diabetic patient with specific foot conditions requires a multiple density insert that is directly formed and molded to their foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. The insert provides total contact with the patient’s foot, including the arch, and meets the requirements for the base layer material.
3. A diabetic patient with a history of foot ulcers requires a multiple density insert that is directly formed and molded to their foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. The insert provides total contact with the patient’s foot, including the arch, and meets the requirements for the base layer material.
4. A diabetic patient with neuropathy requires a multiple density insert that is directly formed and molded to their foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. The insert provides total contact with the patient’s foot, including the arch, and meets the requirements for the base layer material.
5. A diabetic patient with foot deformities requires a multiple density insert that is directly formed and molded to their foot after being exposed to an external heat source of 230 degrees Fahrenheit or higher. The insert provides total contact with the patient’s foot, including the arch, and meets the requirements for the base layer material.