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For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

HCPCS code

Medical Policies and Guidelines for For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe

Related policies from health plans

Orthotics - Medicare Advantage

Similar Codes


ICD10CM codes

E13.621 - Other specified diabetes mellitus with foot ulcer
E11.621 - Type 2 diabetes mellitus with foot ulcer
Z46.81 - Encounter for fitting and adjustment of insulin pump
E09.621 - Drug or chemical induced diabetes mellitus with foot ulcer
E08.621 - Diabetes mellitus due to underlying condition with foot ulcer
E10.621 - Type 1 diabetes mellitus with foot ulcer
E13.61 - Other specified diabetes mellitus with diabetic arthropathy
E13.618 - Other specified diabetes mellitus with other diabetic arthropathy
E13.610 - Other specified diabetes mellitus with diabetic neuropathic arthropathy
Z44.109 - Encounter for fitting and adjustment of unspecified artificial leg, unspecified leg

HCPCS codes

A5507 - For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-
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
A5505 - 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
A5503 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-mol
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

28899 - Unlisted procedure, foot or toes
92325 - Modification of contact lens (separate procedure), with medical supervision of adaptation
28003 - Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas
28810 - Amputation, metatarsal, with toe, single
3754F - Screening tests for diabetes mellitus reviewed, requested, or ordered (DSP)
28805 - Amputation, foot; transmetatarsal
01500 - Anesthesia for procedures on arteries of lower leg, including bypass graft; not otherwise specified
20705 - Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary
28260 - Capsulotomy, midfoot; medial release only (separate procedure)
83525 - Insulin; total