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HCPCS A5500 · Level II · A code

A5500: For diabetics only, fitting (including follow-up), HCPCS Level II A code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for A5500

Medicare payment
$90.63
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
2
MAI 2
OPPS status
SI Y
Non-implantable DME
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

CMS describes HCPCS A5500, added in 1995, as "For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe". DMEPOS fees for A5500, a TS (therapeutic shoes) item, run $90.63 in every contiguous state (floor $81.57, ceiling $108.76) in the October 2026 file. Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 2, Published Contractor Policy). 1 active LCD lists A5500: L33369 (Therapeutic Shoes for Persons with Diabetes). OPPS status indicator Y: Non-implantable DME. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 38; type of service J (diabetic shoes). 11 other active codes open with "For diabetics only"; related codes: A5512, A5513, A5514, A5501.

A5500 descriptor and code status

The October 2026 HCPCS Level II file describes A5500 as “For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes. Although searches often call it the "A5500 CPT code", A5500 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of A5500
FieldValue
Short descriptorDiab shoe for density insert
Added to HCPCS1995-01-01
Last actionN (no maintenance), effective 2005-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator38: DMEPOS orthotics, prosthetics, prosthetic devices and vision services (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceJ: diabetic shoes

Medicare payment for A5500

DMEPOS fees for A5500, a TS (therapeutic shoes) item, run $90.63 in every contiguous state (floor $81.57, ceiling $108.76) in the October 2026 file. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category TS (therapeutic shoes). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for A5500 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$81.57 / $108.76$90.63 (49 states)—AK $90.63, HI $90.63, PR $90.63, VI $90.63

Hospital outpatient (OPPS Addendum B)

Status indicator Y (Non-implantable DME), with no separate OPPS payment rate.

Medically Unlikely Edits for A5500

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 2, Published Contractor Policy). The DME supplier MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for A5500 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy
DME supplier22 Date of Service Edit: PolicyPublished Contractor Policy

The MUE lookup for A5500 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A5500 in v323r0.

A5500 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check A5500 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A5500

1 active Local Coverage Determination and 0 billing and coding articles list A5500. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on A5500

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A5500

CARC 151 · N362

units of A5500 exceed the DME supplier MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for A5500 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A5500 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A5500

What does HCPCS code A5500 describe?

"For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe" (short descriptor "Diab shoe for density insert"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 1995-01-01; last action N (no maintenance) effective 2005-01-01.

Is A5500 a CPT code?

No. A5500 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "A5500 CPT code" mean this Level II code.

What does Medicare pay for A5500?

DMEPOS fees for A5500, a TS (therapeutic shoes) item, run $90.63 in every contiguous state (floor $81.57, ceiling $108.76) in the October 2026 file.

How many units of A5500 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 2, Published Contractor Policy). For the DME supplier MUE (MAI 2), units above 2 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover A5500?

Coverage code D (special coverage instructions apply). 1 active LCD lists A5500: L33369 (Therapeutic Shoes for Persons with Diabetes).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.