2015年10月1日 · Inserts and modifications used with L-coded footwear must be coded using L codes (refer to the Orthopedic Footwear LCD and LCD-related Policy Article for more information). Inserts for missing toes or partial foot amputation should be coded L5000 or L5999, whichever is applicable.

2015年10月1日 · The purpose of a Local Coverage Determination (LCD) is to provide information regarding “reasonable and necessary” criteria based on Social Security Act § 1862 (a) (1) (A) provisions. The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section.

2025年3月12日 · PDAC Coding Guidelines for Off-the-Shelf Diabetic Shoes (A5500) - The information presented in this article comes from the Therapeutic Shoes for Persons with Diabetes Local Coverage Determination (L33369) and related Policy Article (A52501), coding language, coding guidelines, and assessment of samples that have been submitted to the PDAC for ...

2021年11月2日 · • LCA: Therapeutic Shoes for Persons with Diabetes – Policy Article (A52501) For orthopedic footwear used with a leg brace, both the leg brace and the footwear must be billed by the same supplier.

Therapeutic Shoes and inserts are covered under the Therapeutic Shoes for Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). In order for a beneficiary’s equipment to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination must be met.

To provide suppliers with in-depth insight into LCD requirements via claim examples and real life scenarios, Noridian will begin hosting policy specific L200 webinars. Fax claim examples to 701-433-5957

2021年7月20日 · For custom molded shoes (A5501) and inserts (A5513), taking impressions, making casts, or obtaining CAD-CAM images of the beneficiary’s feet. Criterion 5: An objective in-person evaluation at the time of delivery including the following: Assessment with the beneficiary wearing the shoes and inserts: and.

The Local Coverage Determination (LCD) states the supplier must have an in-person evaluation with the beneficiary at the time of selection. If custom-molded shoes (A5501) and inserts (A5513 or A5514) are ordered, the supplier must make impressions, casts, or CAD-CAM images of the beneficiary's feet which will be used in creating positive models ...

2019年4月2日 · This review will determine if the documentation submitted for review meets Medicare’s coverage requirements for Diabetic Shoes and Inserts. Claims where the documentation submitted does not support the coverage requirements will be denied. Affected Code (s) A5500, A5501, A5512, A5513, A5514. Applicable Policy References. 1.

Medical records documenting the foot exam with one of 2A-2F. Documentation must clearly indicate condition is of feet or foot. Q. Can a nurse practitioner (NP) or physician assistant (PA) medical record showing treatment for the diabetic condition suffice if the medical doctor (MD) or doctor of osteopathy (DO) co-signs it? A.