Question 1

What is HCPCS code A5501?

Accepted Answer

HCPCS code A5501 is "Diabetic custom molded shoe". For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe

Question 2

What category is A5501 in?

Accepted Answer

A5501 belongs to HCPCS Category A (Transportation, Medical/Surgical Supplies, Miscellaneous).

Question 3

When should I use HCPCS code A5501?

Accepted Answer

Use A5501 when billing for diabetic custom molded shoe. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is A5501 covered by Medicare?

Accepted Answer

Coverage for A5501 (Diabetic custom molded shoe) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for A5501?

Accepted Answer

Documentation for A5501 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).