August 14, 2017

On August 10, the DME Medicare Administrative Contractors (DME MACs) updated its previous guidance on Healthcare Common Procedure Coding System (HCPCS) A5513. The latest joint bulletin from the DME MACs clarified that the A5513 insoles must be made from a direct molding of patient’s foot or a model of the patient’s foot. The joint bulletin also stated manufacturers with Pricing, Data Analysis and Coding (PDAC) validation letters that allow them to make the insoles from a computerized model of the patient’s foot and these validation letters will be honored through May 31, 2018. Therefore, claims with dates of service on or before May 31, 2018, may continue to be coded using HCPCS A5513 for Medicare so long as the manufacturer has a PDAC validation letter. 

This update is the latest development in what appears to be a fluid situation. APMA plans to meet with CMS officials along with other stakeholders as soon as possible to help resolve this conflict or to seek guidance on how to advise our members on next steps. Check with your shoe/insert vendors on any updates that they may have. Be sure to check back with APMA via the APMA Weekly Focus for additional updates. 

More information:

• DME MAC Joint Bulletin: Correct Coding – A5513 Product Coding Redetermination Project (August 10, 2017)
• DME MAC Joint Bulletin: CORRECT CODING - A5513 CUSTOM MOLDING REQUIREMENTS (July 31, 2017)
• APMA’s previous news coverage

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