Health-Care Common Procedure Coding System A5513 Update

August 7, 2017

The DME Medicare Administrative Contractors (MACs) and the Pricing, Data Analysis and Coding (PDAC) contractor have posted a recent update on the Healthcare Common Procedure Coding System (HCPCS) A5513 (For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer [or higher], includes arch filler and other shaping material, custom fabricated, each), which, arguably, appears to be in conflict with current practice and guidance. You can read the posting at or on the various DME MAC sites. APMA conducted a meeting of internal and external stakeholders (including representatives of AOPA, orthotics manufacturers, and others) on Friday, July 28, in Nashville at APMA’s Annual Scientific Meeting.

APMA plans to meet with CMS officials along with other stakeholders to help resolve this conflict or to seek guidance on how to advise our members on next steps. Check with your orthotics vendors on any updates that they have, and be sure to check back with APMA via the APMA Weekly Focus for additional updates. APMA believes DMEPOS guidance should reflect current technology while also ensuring the safety of our members’ patients.

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