04/04/2018    Paul Kesselman, DPM

Therapeutic Shoe Inserts Update

It is important to note that as of April 1, 2018,
you are responsible to use the appropriate codes
for your custom therapeutic shoe inserts.
Since there is no financial incentive to using
the wrong code and only a financial disincentive
in choosing the wrong code (refunds to Medicare),
it is imperative that you choose the correct code
describing your inserts.

As of April 1 2018 all custom fabricated inserts
made via the: Milling process (using a virtual
positive) should be coded as K0903; Molding
process (using a positive physical mold) should
be coded as A5513.

The fabricating process should be obtained in
writing from your laboratory.

During the current transitional period of April 1
2018 through July 31, 2018, validation letters
from the PDAC are optional for K0903 and those
devices currently validated as A5513 but
described as K0903, should be billed as the
latter. Devices which are currently validated as
A5513 and manufactured as described (molded) can
continue to be billed as A5513.However, as of
Dates of Service August 1 2018, that option ends
with the termination of the transition period. At
that time open ended validation letters must be
posted on the PDAC website for use of either
code.

It is interesting to note that either devices can
be initiated with either a negative cast or foam
box impression or a scan of the patient's foot.
The distinguishing factor is how those negatives
are then utilized at the fabricators facility.

Both types of inserts are to be reimbursed by
Medicare at the same national rate of $43.56 per
insert.

What will be interesting to see is how non
Medicare carriers embrace the new code, whether
they pay the same for both codes and how
secondary cross over claims from Medicare are
handled.

A huge round of appreciative applause goes to
APMA, AOPA and Cong. Brad Wenstrup for getting
through the bureaucratic CMS maze. Their
assistance was instrumental at getting Medicare
to see the light of day and paying the same for
these two custom inserts.

Paul Kesselman, DPM, Woodside, NY

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