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For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe

HCPCS code

Medical Policies and Guidelines for For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe

Related policies from health plans

Orthotics - Medicare Advantage

Similar Codes


ICD10CM codes

E11.621 - Type 2 diabetes mellitus with foot ulcer
E13.621 - Other specified diabetes mellitus with foot ulcer
E10.621 - Type 1 diabetes mellitus with foot ulcer
E08.621 - Diabetes mellitus due to underlying condition with foot ulcer
E09.621 - Drug or chemical induced diabetes mellitus with foot ulcer
Z46.81 - Encounter for fitting and adjustment of insulin pump
Z86.31 - Personal history of diabetic foot ulcer
I70.534 - Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel
I70.634 - Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoo
I70.334 - Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and

HCPCS codes

A5506 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-mol
A5504 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-mol
A5507 - For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-
A5505 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-mol
A5503 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-mol
A5508 - For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
A5500 - For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf de
A5501 - For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from
A5510 - For diabetics only, direct formed, compression molded to patient's foot without external heat source
A5513 - For diabetics only, multiple density insert, custom molded from model of patient's foot, total conta

CPT4 codes

28810 - Amputation, metatarsal, with toe, single
28003 - Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas
28805 - Amputation, foot; transmetatarsal
28899 - Unlisted procedure, foot or toes
28296 - Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsa
28293 - Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of joint with implant
28150 - Phalangectomy, toe, each toe
28110 - Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
29550 - Strapping; toes
3754F - Screening tests for diabetes mellitus reviewed, requested, or ordered (DSP)