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HCPCS A5505 · Level II · A code

A5505: For diabetics only, 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 A5505

Medicare payment
$45.79
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

HCPCS Level II A5505 reads "For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe" in the October 2026 file; it dates from 1995. The October 2026 DMEPOS fee schedule (category TS, therapeutic shoes) sets A5505 at $45.79 in every contiguous state (floor $41.21, ceiling $54.95). CMS caps A5505 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 2, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD lists A5505: 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: A5500, A5512, A5513, A5514.

A5505 descriptor and code status

The October 2026 HCPCS Level II file describes A5505 as “For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.

HCPCS file attributes of A5505
FieldValue
Short descriptorDiab shoe w/metatarsal bar
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 A5505

The October 2026 DMEPOS fee schedule (category TS, therapeutic shoes) sets A5505 at $45.79 in every contiguous state (floor $41.21, ceiling $54.95). 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 A5505 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$41.21 / $54.95$45.79 (49 states)—AK $45.79, HI $45.79, PR $45.79, VI $45.79

Hospital outpatient (OPPS Addendum B)

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

Medically Unlikely Edits for A5505

CMS caps A5505 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 2, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 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 A5505 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 A5505 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A5505 in v323r0.

A5505 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 A5505 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A5505

1 active Local Coverage Determination and 0 billing and coding articles list A5505. 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 A5505

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A5505

CARC 151 · N362

units of A5505 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 A5505 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A5505 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 A5505

What does HCPCS code A5505 describe?

"For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe" (short descriptor "Diab shoe w/metatarsal bar"), 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 A5505 a CPT code?

It is not. A5505 belongs to the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for A5505?

The October 2026 DMEPOS fee schedule (category TS, therapeutic shoes) sets A5505 at $45.79 in every contiguous state (floor $41.21, ceiling $54.95).

How many units of A5505 can be billed per day?

CMS caps A5505 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy); DME supplier 2 (MAI 2, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 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 A5505?

Coverage code D (special coverage instructions apply). 1 active LCD lists A5505: 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.