CMS amends custom diabetic insert coding

The Centers for Medicare and Medicaid Services have amended a recent coding clarification regarding custom-fabricated diabetic shoe inserts, which two specialty organizations had criticized as being unnecessarily strict and a detriment to advanced technology. According to the original clarification, to bill Medicare for a custom-fabricated diabetic insert using HCPCS code A5513, practitioners would have had to create a physical model of the patient’s foot and then use that mold to fabricate the insert. Any process that used virtual models to create inserts, either through direct milling or other means, would not have met the standard and instead would have had to be billed using the code A9270, which describes statutorily noncovered services.

The Centers for Medicare and Medicaid Services have amended a recent coding clarification regarding custom-fabricated diabetic shoe inserts, which two specialty organizations had criticized as being unnecessarily strict and a detriment to advanced technology. According to the original clarification, to bill Medicare for a custom-fabricated diabetic insert using HCPCS code A5513, practitioners would have had to create a physical model of the patient’s foot and then use that mold to fabricate the insert. Any process that used virtual models to create inserts, either through direct milling or other means, would not have met the standard and instead would have had to be billed using the code A9270, which describes statutorily noncovered services.

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CMS amends custom diabetic insert coding