How To Use HCPCS Code A5514

HCPCS code A5514 describes a multiple density insert that is custom fabricated for diabetics. This insert is made using direct carving with cam technology, starting from a rectified cad model created from a digitized scan of the patient. It provides total contact with the patient’s foot, including the arch, and is designed to offer optimal support and comfort. The insert includes a base layer made of a minimum of 3/16 inch material with a shore a 35 durometer or higher. It also includes arch filler and other shaping material to ensure a customized fit for each patient.

1. What is HCPCS A5514?

HCPCS code A5514 is used to identify a specific type of multiple density insert that is custom fabricated for diabetics. This code is used to indicate the provision of a highly personalized and specialized insert that is designed to meet the unique needs of diabetic patients. It is important to note that this code is only applicable for diabetics and should not be used for other patients.

2. Official Description

The official description of HCPCS code A5514 is as follows: “For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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 of this code is “Mult den insert dir carv/cam.”

3. Procedure

1. The provider begins by taking a digitized scan of the patient’s foot using specialized scanning equipment.
2. Using the scan data, a rectified cad model is created to serve as the basis for the custom fabrication process.
3. The provider utilizes direct carving with cam technology to shape the insert according to the patient’s specific foot contours and requirements.
4. The insert is fabricated using multiple density materials, with a base layer of at least 3/16 inch material of shore a 35 durometer or higher.
5. The insert is designed to provide total contact with the patient’s foot, including the arch, ensuring optimal support and comfort.
6. Arch filler and other shaping materials are incorporated into the insert to further customize its fit and functionality.
7. Each insert is custom fabricated to meet the unique needs of the individual patient.

4. When to use HCPCS code A5514

HCPCS code A5514 should be used when providing a custom fabricated multiple density insert specifically designed for diabetics. This code is intended for use in cases where the patient requires a highly personalized and specialized insert that offers total contact with the foot, including the arch. It is important to ensure that the patient meets the eligibility criteria for this code, which is limited to diabetics only.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A5514, healthcare providers need to ensure that the following documentation requirements are met:

• A detailed description of the custom fabrication process, including the use of direct carving with cam technology and the materials used.
• Documentation of the patient’s diabetic status, including relevant medical records or diagnosis codes.
• A record of the patient’s foot scan and the creation of the rectified cad model.
• Documentation of the specific materials used in the fabrication of the insert, including the base layer material and the durometer measurement.
• Documentation of the inclusion of arch filler and other shaping materials in the insert.
• A clear indication that the insert is custom fabricated for the individual patient.

6. Historical Information and Code Maintenance

HCPCS code A5514 was added to the Healthcare Common Procedure Coding System on January 01, 2019. As of its addition, 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 is classified under the type of service code J, which specifically refers to diabetic shoes.

7. Medicare and Insurance Coverage

HCPCS code A5514 is subject to coverage instructions, as indicated by the coverage code D. This means that special coverage instructions may apply when billing for this code. The pricing indicator code for this code is 38, which falls under the category of orthotics, prosthetics, prosthetic devices, and vision services. The multiple pricing indicator code for this code is A, indicating that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code A5514 should be billed:

1. A diabetic patient requires a custom fabricated multiple density insert that provides total contact with their foot, including the arch. The insert is made using direct carving with cam technology and includes arch filler and other shaping materials.
2. A diabetic patient with specific foot abnormalities needs a highly personalized insert that offers optimal support and comfort. The insert is custom fabricated using a rectified cad model created from a digitized scan of the patient’s foot.
3. A diabetic patient with a history of foot ulcers requires a custom fabricated insert that ensures total contact with their foot, including the arch. The insert is made using multiple density materials and includes arch filler for additional support.
4. A diabetic patient with neuropathy needs a custom fabricated insert that provides total contact with their foot, including the arch. The insert is made using direct carving with cam technology and includes other shaping materials to accommodate the patient’s specific foot contours.
5. A diabetic patient with a high arch requires a custom fabricated insert that offers optimal support and comfort. The insert is made using a rectified cad model created from a digitized scan of the patient’s foot and includes arch filler to provide the necessary support.