The Pricing, Data Analysis and Coding (PDAC) contractor announced that based on a previously published coding clarification, it was initiating a coding redetermination project for diabetic inserts described by Healthcare Common Procedure Coding System (HCPCS) code A-5513 (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)). Manufacturers and central fabrication facilities who want to have their products PDAC verified for A-5513 must submit a new application by May 31, 2018, for all products previously verified by the PDAC. PDAC suggests that applications be submitted well before the deadline.
The notice stated that products that are currently PDAC verified for A-5513 may continue to be billed using A-5513 through May 31, 2018. Claims with a date of service on or after June 1, 2018, will require a new PDAC coding verification.
In July, the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) published a joint publication indicating that in order to meet the requirements of the HCPCS code descriptor, diabetic inserts billed using A-5513 must be molded over an actual model of the patient’s foot. According to the American Orthotic & Prosthetic Association, facilities that fabricate diabetic inserts described by A-5513 for use by their own patients are not required to obtain PDAC verification, however they must meet the requirements of the code descriptor, which includes the creation of a positive model of the patient’s foot.
