How much does Medicare allow for shoes and inserts for patients with diabetes?
For devices dispensed between 1/1/06 and 12/31/06, Medicare allows: Depth shoes, A5500: $118.75 per pair plus up to three pair Prefabricated heat molded insoles (A5512) at $48.84 per pair or up to three pair Custom Insoles (A5513) at $72.28 per pair. Custom-molded shoes (A5501) are $356.08 per pair plus up to two pair Custom Insoles (A5513) at $72.28 per pair. PFA Reimbursement and Government Issues director Janis Gregory suggests keeping the following points in mind: 1. A-codes are not fee schedule items. 2. The law that established the benefit itself set the fees, and it will take another law to change the fees. 3. These are maximum national allowable amounts. 4. Each DMERC may calculate the formula differently, but the amount should not be higher than listed above. The fees usually vary from state to state. 5. All increases from the original pricing are tied to DME (Durable Medical Equipment) increases.
