HCPCS - A5500 denied by DMERC

We always receive denial for procedure A5500 from DMERC - A.

1) as as Non-covred service, decision based on LMRP & LCD policies. (OR)

2) as claim services lacks info needed for adjudication, Missing/In-complete or invalid modifier.

Does any one have an idea on how to bill this service..

Thanks in Advance!!!
Frank Nikolaus

re: HCPCS - A5500 denied by DMERC

A5500 For diabetics only, fitting (including follow-up) custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe. The M. D. or D. O. who is treating the patient for diabetes must certify that the individual:
1. Has diabetes.
2. Has one of more of the following conditions:
-History of partial or complete foot amputation
-History of previous foot ulceration
-History of pre-ulcerative callus
-Peripheral neuropathy with evidence of callus formation
-Poor circulation
-Foot deformity
https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/therapeutic_shoes_for_persons_with_diabetes.htm

re: HCPCS - A5500 denied by DMERC

Thank you so much,

But, can it be provided more than once per calender year???? Also can we bill the patient for the additional shoes that he/she got??

re: HCPCS - A5500 denied by DMERC

last I heard: Eligible beneficiaries may receive one pair of custom-molded shoes or one pair of depth shoes per calendar year. Beneficiaries receiving custom-molded shoes may receive two pairs of inserts (in addition to the inserts provided with the shoes) per year. Beneficiaries receiving depth shoes are eligible for up to three additional pairs of inserts each year.

re: HCPCS - A5500 denied by DMERC

That was very very helpful.... Thank you so much,,,... Have a happy week end.