Does A5508 require prior authorization?

No, A5508 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A5508?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Backwork Sign up free

`A5508`, For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Supplier must have received a signed Standard Written Order (SWO)/Written Order Prior to Delivery (WOPD) before delivering DMEPOS base items; the WOPD must list the base item and may list associated options/accessories/supplies.
Supplier must maintain proof of delivery (POD) documentation in files and make it available to the Medicare contractor upon request.

For diabetic/at-risk patients: ongoing follow-up recommended: "As a preventive measure, this group of patients should be followed on a regular basis for the development of pathology to ensure quick interventions as needed." (documentation of monitoring/follow-up)

Key Coverage Criteria

Therapeutic shoes and related inserts are covered when the item is an eligible Medicare benefit category and is reasonable and necessary for diagnosis or treatment of illness/injury or to improve the functioning of a malformed body member.
Therapeutic shoes are provided for persons with diabetes when the above Medicare coverage criteria are met.
A custom-molded shoe (HCPCS A5501) is covered when the beneficiary has a foot deformity that cannot be accommodated by a depth shoe and the nature and severity of the deformity are documented.
Separate inserts may be covered and dispensed independently if the supplier documents in writing that the beneficiary has appropriate footwear (depth shoes or custom-molded shoes) into which the insert can be placed.
Orthosis (foot orthotics) and/or prosthesis is medically necessary when care is prescribed by a physician, nurse practitioner, podiatrist or other health professional who is qualified to prescribe orthotics and/or prosthetics according to State law.
Orthosis or prosthesis is medically necessary when the orthosis or prosthesis will significantly improve or restore physical functions required for mobility related activities of daily living (MRADL's).

3 Active Policies

ANTHEM-CG-DME-19, Therapeutic Shoes, Inserts, or Modifications for Individuals with Diabetes

L33369, Therapeutic Shoes for Persons with Diabetes

AETNA-CPB-0451, Foot Orthotics

`A5508`, For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

A5508, For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`A5508`, For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or