04/29/2024

Medicare Advantage Plan Payments and Coding for Diabetic Shoes and Inserts

How do Medicare Advantage Plans pay for diabetic shoes? I was told by UHC Medicare Advantage that A5500 was a custom shoe? Do they want it coded a different way than Medicare?

Medicare Advantage plans and traditional Medicare would be billed with the same procedure codes for diabetic shoes and inserts. Procedure codes are standardized and cannot be interpreted differently from insurance carrier to insurance carrier. Medicare Advantage plans may have some slight differences in coverage, but must provide the same basic benefit as traditional Medicare. If a patient is enrolled in one of these plans, be sure to review any medical policies for medical necessity to ensure claims are reimbursed based on the plans’ guidelines.