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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 sha...

HCPCS code

Medical Policies and Guidelines for 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 sha...

Related policies from health plans

Therapeutic Shoes, Inserts or Modifications for Individuals with Diabetes
CG-DME-19 Therapeutic Shoes, Inserts or Modifications for Individuals with Diabetes
Orthotics - Medicare Advantage

Similar Codes


ICD10CM codes

Z86.31 - Personal history of diabetic foot ulcer
E13.621 - Other specified diabetes mellitus with foot ulcer
E11.621 - Type 2 diabetes mellitus with foot ulcer
E10.621 - Type 1 diabetes mellitus with foot ulcer
E13.61 - Other specified diabetes mellitus with diabetic arthropathy
E09.621 - Drug or chemical induced diabetes mellitus with foot ulcer
L97.502 - Non-pressure chronic ulcer of other part of unspecified foot with fat layer exposed
E08.621 - Diabetes mellitus due to underlying condition with foot ulcer
E13.618 - Other specified diabetes mellitus with other diabetic arthropathy
L97.512 - Non-pressure chronic ulcer of other part of right foot with fat layer exposed

HCPCS codes

A5513 - For diabetics only, multiple density insert, custom molded from model of patient's foot, total conta
A5512 - For diabetics only, multiple density insert, direct formed, molded to foot after external heat sourc
A5514 - For diabetics only, multiple density insert, made by direct carving with cam technology from a recti
K0903 - For diabetics only, multiple density insert, made by direct carving with cam technology from a recti
A5510 - For diabetics only, direct formed, compression molded to patient's foot without external heat source
A5500 - For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf de
A5506 - 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
A5504 - For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-mol

CPT4 codes

29581 - Application of multi-layer compression system; leg (below knee), including ankle and foot
0335T - Insertion of sinus tarsi implant
73630 - Radiologic examination, foot; complete, minimum of 3 views
29582 - Application of multi-layer compression system; thigh and leg, including ankle and foot, when perform
28003 - Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areas
95250 - Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for
95249 - Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for
28001 - Incision and drainage, bursa, foot
95251 - Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for
4305F - Patient education regarding appropriate foot care and daily inspection of the feet received (CWC)