How To Use HCPCS Code A5513

HCPCS code A5513 describes a specific type of multiple density insert that is custom molded from a model of the patient’s foot. This insert provides total contact with the patient’s foot, including the arch, and is designed specifically for diabetics. It includes a base layer made of a minimum of 3/16 inch material with a shore a 35 durometer or higher. The insert also includes an arch filler and other shaping material. Each insert is custom fabricated to meet the unique needs of the patient.

1. What is HCPCS A5513?

HCPCS code A5513 is used to identify a custom molded multiple density insert that is specifically designed for diabetics. This insert provides total contact with the patient’s foot, including the arch, and is custom fabricated based on a model of the patient’s foot. It includes a base layer made of a minimum of 3/16 inch material with a shore a 35 durometer or higher. The insert also includes an arch filler and other shaping material to ensure a proper fit and support for the patient’s foot.

2. Official Description

The official description of HCPCS code A5513 is as follows: “For diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each.” The short description for this code is “Multi den insert custom mold.”

3. Procedure

1. The procedure for HCPCS code A5513 involves taking a model of the patient’s foot to create a custom mold.
2. The custom mold is then used to fabricate a multiple density insert that provides total contact with the patient’s foot, including the arch.
3. The insert is made with a base layer of at least 3/16 inch material with a shore a 35 durometer or higher.
4. An arch filler and other shaping material are included in the insert to ensure proper fit and support.
5. Each insert is custom fabricated to meet the unique needs of the patient.

4. When to use HCPCS code A5513

HCPCS code A5513 should be used when providing a custom molded multiple density insert for diabetic patients. This code is specifically for inserts that are custom fabricated from a model of the patient’s foot and provide total contact with the foot, including the arch. It is important to ensure that the insert meets the requirements outlined in the official description, including the minimum material thickness and durometer rating.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A5513, healthcare providers should ensure that the documentation supports the medical necessity of the custom molded insert for the diabetic patient. This may include documentation of the patient’s foot condition, the need for total contact and support, and any specific requirements for the insert. It is also important to follow any specific billing guidelines provided by Medicare or other insurance carriers to ensure accurate and timely reimbursement.

6. Historical information and Code Maintenance

HCPCS code A5513 was added to the Healthcare Common Procedure Coding System on January 01, 2006. As 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. The code falls under the category of orthotics, prosthetics, prosthetic devices, and vision services, with pricing subject to floors and ceilings.

7. Medicare and Insurance Coverage

HCPCS code A5513 is eligible for coverage by Medicare and other insurance carriers. 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 is A, which means it is not applicable as HCPCS priced under one methodology. Providers should refer to the Medicare Carriers Manual Reference Section Number 2134 for specific guidelines and requirements for billing this code.

8. Examples

Here are five examples of when HCPCS code A5513 should be billed:

1. A diabetic patient with foot deformities requiring a custom molded insert for total contact and support.
2. A diabetic patient with neuropathy and foot ulcers in need of a custom fabricated insert to offload pressure and promote healing.
3. A diabetic patient with high arches and foot pain requiring a custom molded insert to provide arch support and alleviate discomfort.
4. A diabetic patient with flat feet and pronation issues needing a custom fabricated insert to correct alignment and improve gait.
5. A diabetic patient with foot instability and balance problems requiring a custom molded insert to provide stability and prevent falls.