CORRECT CODING – FULL LENGTH ROCKER SOLES ADDED TO THERAPEUTIC SHOES


DME MAC Joint Publication

A recent analysis of HCPCS code A5507 (FOR DIABETICS ONLY, NOT OTHERWISE SPECIFIED MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE, PER SHOE) revealed that claim lines submitted often were incorrectly coded. Correct coding requires the use of a specific HCPCS code for Medicare billing when a specific code exists that appropriately describes the item provided. Use of a miscellaneous or NOC (not otherwise classified) code for billing when a specific code exists is incorrect coding. The most common incorrectly coded item in this report is for full length rocker soles.

Full length rocker soles added to therapeutic shoes are correctly billed with HCPCS code:

A5503 - FOR DIABETICS ONLY, MODIFICATION (INCLUDING FITTING) OF OFF-THE-SHELF DEPTH-INLAY SHOE OR CUSTOM-MOLDED SHOE WITH ROLLER OR RIGID ROCKER BOTTOM, PER SHOE

Correct coding is an essential element for correct claim payment. The Pricing, Data Analysis, and Coding (PDAC) contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail questions to the PDAC by completing the DME PDAC Contact Form.

Published by Noridian as the PDAC, November 2017.  Republished by Palmetto GBA as the PDAC, January 2019.



Last Updated: 11/29/2017