03/08/2017

Billing L5000 for Beneficiaries without Diabetes

In the past, I have billed out for a toe-filler to a diabetic patient status post a hallux amp. Does the patient need to be a diabetic to bill out for a toe filler? I just amputated a great toe on a non diabetic do they qualify? L5000 is the code in question.

Shoe inserts for beneficiaries with missing toes or partial foot amputations who are not diabetic are considered for coverage under the prosthetic benefit. Code L5000 is described by:

L5000: PARTIAL FOOT, SHOE INSERT WITH LONGITUDINAL ARCH, TOE FILLER

For beneficiaries who are non-diabetic and require accommodation of missing foot digit(s) or forefoot, suppliers must only bill code L5000. Codes A5512 and A5513 describe inserts used with therapeutic shoes provided to persons with diabetes and must not be billed for non-diabetic beneficiaries.