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07/08/2025 Ron Werter, DPM

Custom Diabetic Inserts

I was referred a Medicare patient with a chronic
DFU to make custom inserts (A5513) He recently
received shoes and pre-fab inserts from a vendor
this calendar year. Am I allowed to make (and get
paid for) a pair of the custom insert (A5513)
without dispensing the shoes and especially since
he has gotten 3 pairs of the A5512

Ron Werter, DPM, NY, NY

Response from thedoctorlien.com: This is an
excellent question and one I both faced clinically
when I was in practice and continues to be
problematic for both the supplier and patient.
First off, if a patient has already received shoes
and three pairs of inserts, no matter which code,
then they have exhausted their Medicare coverage.

If the patient has a clinical need for custom
inserts then they need to be informed that
Medicare will not cover these devices simply
because the Medicare policy only permits them to
receive three pairs of inserts, regardless of
their clinical needs.

As for which device to chose and resolve, you have
two choices, again both of which will be the
financial burden for the patient and you should
have a frank discussion with them about the
advantages/disadvantages to both:

If you choose to go the custom molded route
(A5513) or custom milled route (A5514), the
patient should receive three of those. The patient
should sign an ABN and if they wish the claim to
be submitted to Medicare, then submit the claim
with the GA modifier for the LT and RT. Each claim
line billed with 3 units.

This will signify a rejection to Medicare for not
medically necessary (according tot their policy)
and result a patient responsibility (PR)
rejection. To determine whether your vendor is
providing an A5513 or A5514, I suggest you contact
them.

Your other choice and my preference is to make the
patient a high quality accommodative foot
orthotic, consistent with L3000-L3020 which will
last a few years. This choice would also not be
covered by Medicare and the claim would be
submitted with a GY modifier (not covered by
Medicare) and again generate a patient
responsibility (PR) remark code.

In both of the above scenarios if the patient has
a private (not Medicaid) secondary insurance,
they may (or may not) pick up the charges and pay.

Additionally, if a patient has a pair of shoes
which already meet the therapeutic shoe policy,
then coverage for the inserts is not predicated on
providing them with a shoe at the same time or
ever. But that is an extra bonus of information
you can tuck away for future reference.

In this case, the patient has already exhausted
any and all benefits for the current calendar
year.

Paul Kesselman, DPM, Oceanside, NY

Other messages in this thread:

11/22/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/17/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/16/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/14/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/09/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/08/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/07/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/02/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

11/01/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/31/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/26/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/25/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/24/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/20/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.
CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/18/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/17/2006

New Custom Diabetic Inserts For Only $22 A Pair

Orthofeet is glad to announce its new custom diabetic inserts, which received SADMARC Code verification A5513. These custom inserts are fabricated by the most advanced computerized system, with arch filler and forefoot accommodations, for superior support and protection.
-
Now you can offer your patients state of the art prefab and custom inserts along with the best fitting diabetic shoes, and save: Stretchable Shoes - $42.00 a pair; Leather Shoes - $48.00 to $52.00 a pair; Prefab Inserts - $8.95 a pair; Custom Inserts - $22.00 a pair;

100% Medicare Compliant
http://www.orthofeet.com/ ----------------- 800-524-2845

10/17/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.

CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/13/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.
CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/12/2006

New Custom Diabetic Inserts For Only $22 A Pair

Orthofeet is glad to announce its new custom diabetic inserts, which received SADMARC Code verification A5513. These custom inserts are fabricated by the most advanced computerized system, with arch filler and forefoot accommodations, for superior support and protection.
-
Now you can offer your patients state of the art prefab and custom inserts along with the best fitting diabetic shoes, and save: Stretchable Shoes - $42.00 a pair; Leather Shoes - $48.00 to $52.00 a pair; Prefab Inserts - $8.95 a pair; Custom Inserts - $22.00 a pair;

100% Medicare Compliant
http://www.orthofeet.com/ ----------------- 800-524-2845

10/11/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.
CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/10/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.
CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/09/2006

New Custom Diabetic Inserts For Only $22 A Pair

Orthofeet is glad to announce its new custom diabetic inserts, which received SADMARC Code verification A5513. These custom inserts are fabricated by the most advanced computerized system, with arch filler and forefoot accommodations, for superior support and protection.
-
Now you can offer your patients state of the art prefab and custom inserts along with the best fitting diabetic shoes, and save: Stretchable Shoes - $42.00 a pair; Leather Shoes - $48.00 to $52.00 a pair; Prefab Inserts - $8.95 a pair; Custom Inserts - $22.00 a pair;

100% Medicare Compliant
http://www.orthofeet.com/ ----------------- 800-524-2845

10/06/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.
CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/05/2006

CUSTOM DIABETIC INSERTS ONLY $18 PER PAIR!!!

TC LABS has received the coding verification letter from SADMERC for A5513. Inserts are shipped in 3 days, and all devices have the patient name and pair number on them.
CUSTOM INSERTS $18/pair PREFORMS $6.50/pair (50 or more pre-forms, $6 per pair). JUST SNEAKERS SHOES $49.90/pair

INTRODUCTORY OFFER 3 pr. custom + 1 pr. shoes $99.90 3 pr. preforms + 1 pr. shoes $69.90

For information and orders CALL 800-983-7370 FAX 800-983-7571 or e-mail tclabs@sbcglobal.net

10/04/2006

New Custom Diabetic Inserts For Only $22 A Pair

Orthofeet is glad to announce its new custom diabetic inserts, which received SADMARC Code verification A5513. These custom inserts are fabricated by the most advanced computerized system, with arch filler and forefoot accommodations, for superior support and protection.
-
Now you can offer your patients state of the art prefab and custom inserts along with the best fitting diabetic shoes, and save: Stretchable Shoes - $42.00 a pair; Leather Shoes - $48.00 to $52.00 a pair; Prefab Inserts - $8.95 a pair; Custom Inserts - $22.00 a pair;

100% Medicare Compliant
http://www.orthofeet.com/ ----------------- 800-524-2845