Therapeutic Shoes for Diabetics - Revision of Requirement for Coding Verification Review
A revision of the medical policy on Therapeutic Shoes for Persons with Diabetes which was published in the December DMERC Supplier Manual update added a new requirement for Coding Verification Review by the SADMERC for shoes and inserts for claims with dates of service on or after 1/1/06. That requirement is being changed. The requirement for Coding Verification Review for therapeutic shoes (A5500) is being eliminated. The requirement for Coding Verification Review of inserts (new codes A5512 and A5513 in 2006) is being delayed and will be effective for claims with dates of service on or after July 1, 2006. A revision of the policy with a corrected statement will be published in a future Supplier Manual update.
Manufacturers that have already submitted their products for review under current codes K0628 or K0629 will not have to resubmit for A5512 or A5513. The SADMERC will make that change in the Classification List by a direct crosswalk.
If manufacturers have not yet submitted products for A5512 or A5513, they are urged to do so as soon as possible in order to have them coded by the July 1, 2006 implementation date.
For A5512, the SADMERC requires at least one sample of the product to accompany the application.
For A5513, the SADMERC requires either a 4 inch by 4 inch by 1/2 inch sample of the base layer material(s) used in the custom manufacturing process, photos of the process and a narrative description of the general techniques used to construct the devices, or an affidavit from a senior management official attesting to the name brand, source and durometer reading of the product(s) used for the base layer, photos of the process of manufacture, and a narrative of the construction process.
Applications for Coding Verification Review are available on the SADMERC website found at www.palmettogba.com. Look under "Other Partners" at the bottom of the home page, click on "SADMERC". When the SADMERC home page opens, click on "HCPCS Coding Verification Applications" on the right hand menu. When a second menu with other options appears, click on "Applications for HCPCS Coding Verification Review" and select the one for Therapeutic Shoes and Inserts for Diabetics.
On the second menu print off the appropriate checklist from "Checklists for Coding Verification Applications" to assist in ensuring all items needed by the review team are present before sending in the application and sample(s).
Published by Palmetto GBA as the SADMERC, December 2005. Republished by Noridian as the PDAC, August 2008. Republished by Palmetto GBA as the PDAC, January 2019.