What Is Covered by Medicare?
Medicare covers 80% of the cost of the following (per year):

  • One pair of  Depth Shoes.
  • 3 pair of inserts.

Billing Codes

A5500 For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe.
A5512 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 ¼ inch material of shore a 35 durometer, or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each.
A5513 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.
Toe Filler
L5000 		Partial foot, shoe insert with longitudinal arch, toe filler (Inserts for missing toes or partial foot amputation).
(A5500, A5512 and A5513).(A
Code Modifiers:
KX Specific required documentation on file
LT Left side
RT Right side
Coverage – Diabetic shoes, inserts and/or modifications are covered if the following criteria are met:
1) Patients who have diabetes mellitus (ICD-9-CM diagnosis code 250.00-250.91) and:
2) This patient has one or more of the following conditions:
a. History of partial or complete amputation of the foot.
b. History of previous foot ulceration.
c. History of pre-ulcerative callus.
d. Peripheral Neuropathy with evidence of callus formation.
e. Foot deformity.
f. Poor circulation.


3) The certifying physician, who is managing the patient’s systemic diabetes condition has certified that indications (1) and (2) are met and that he/she is treating the patient under a comprehensive plan of care for his/her diabetes and that the patient needs diabetic shoes. The certifying physician must be an M.D. or D.O.

This policy requires that the certifying physician, providing the medical care for the diabetic condition must sign a statement that the conditions stated above are met.

The prescribing physician may be a podiatrist, M.D. or D.O. and should write the order for the therapeutic shoes, modifications, and inserts.

The supplier, the person or entity furnishing the shoes, modifications, or inserts may be a podiatrist, pedorthist, orthotist, prosthetist, or other qualified individual. The supplier should bill Medicare for the service.