"A" Code Responses
Description
Collection
Title:
"A" Code Responses
Text:
To the List,
First, my apologies--between my browser and the world of Microsoft,
the HTML codes —, “, A” were inserted instead of hyphens in
my message--surely an ideal way to confound a coding issue if I ever saw one!
(although this did not affect all recipients of my message).
Second, it looks like my HCPCS book (published by the AMA press) is in
error when it (quite clearly) designates the three new A codes as
Noncovered. One is left to wonder how much other misinformation is out
there. You might want to keep that in mind if one of your physicians (or
more likely their MAs or PAs have taken time to peruse the AMA version of
reality) confronts you over what Medicare covers.
Here are the responses to date to my query concerning the replacements for
A5502:
As I read it, the only code that is not covered is
A5510. Since it is pressure molded as it is worn it
does not meet the Medicare standard of being total
contact at the time of delivery. The other two codes
are covered. The reimbursement rate stayed the same as
for last years A5502. My reading of the new regs was
validated this past week in a company wide coding
meeting.
Medicare only changed the definitions to better
reflect what the patient gets.
---
I think you are reading it wrong. Just the one code is no longer covered.
Go to www.pedorthics.org to see what the new regulations are.
---
What are the 8221 codes you are refering to?
The new A codes did to our knowledge eliminate the 5502, it was way to
abused.
The three new codes are 5509 - 11 and one of them which I can't remember at
this time, I thinks it's 5510 is basicly an insert just stuck in the shoe
with no premolding. This one is not going to be covered by Medicare
according to the AOPA in Advance notice that is. I'm at home, not in the
office and using my memory. Let me know if you have other questions.
---
Where did you get your new 2002 hspc book I beed one and would like to know
where I can purchase it..... also am concerned about the insole question and
would like to know as well if this is true .
---
As to your question on the A5509, 5510 and 5511 codes. It goes like this.
A5509 and A5510 are for prefabricated multi density diabetic insoles. Under
the A5509 code the device must be heated - either with a heat gun or in an
oven and pulled over a cast. Since you are dealing with Plastazote which is
very accomodative it is probably best to use a heat gun sparingly, and pull
over a cast in only the extreme cases. If you do this you will get reimbused
under 5509. If you bill under 5510 you will NOT get reimbursed. Even though
you can essentially accomplish the same as heating by letting the patient
mold the insoles via weight. A5511 is for custom insoles, not prefab.
---
We have been unsuccessful at collecting from Medicare on the A5509 which
should be the prefab FO. The A5511, however, is covered by Medicare for
Diabetics provided that they meet the criteria laid out by Medicare. (We
almost always do these anyway, I guess it is just because I don't feel good
about fitting off-the-shelf orthotics even if they are first heated in a
convection oven.) Medicare has paid us many times already over the past
month an a half for this code...Unfortunately, they still only pay about
$65.00 per pair. This sucks!!! At this rate, by the time I or one of my
Cpeds does an eval, listens to their ENTIRE medical history, fits them with
shoes, takes an impression or cast of their foot, makes the mold fabricates
the orthoses and sees them again for a fitting of the orthotics, we have
definitely lost money. One can rationalize that we will make it back on
other devices, but unless we want to turn these people away, or make them
pay out-of-pocket like most facilities do, we just have to take it. This is
a subject that we have had much discussion about in recent months, and are
considering these types of options. I would love to hear what the other
responses show. If you don't post them, please at least forward them to me.
Thanks.
----
Send me a Fax number and I'll share a copy of the AOPA in Advance with you.
It's my only resource on this issue at this point.
----
Harry, my comment on your post goes like this. In our Dmerc region D we were
told that A5509, A5510, A5511 are all set at $33.00. However, that is likely
to change soon because they are still trying to figure out the whole mess.
Codes —, “, A” are mystery codes to me. With an x as the
alpha the codes are medcaid codes. I forgot which ones were which but some
are not covered.
----
As a Pedorthist and a member of the PFA (Pedorthic footwear Association) I
have learned that the original insert code is still in use until March 2002.
The new codes are tricky. The code for prefabricated inserts is NOT covered.
The code for heat formed (heatgun etc.) prefabricated inserts are covered.
The code for custom molded inserts are covered. The catch is this, the
allowables are the same (around $60-65/pair) even for the custom molded
inserts. Three pairs/year are still allowed (or two pairs and a
modification). PFA is lobbying for Medicare to consider paying more for the
custom molded inserts ( a total of approx. $180-190/ pair) but reducing the
allowed amount to cover only one pair a year (which doesn't hurt the
government's budget because the price they are lobbying for is exactly the
same per year as three sets of the other inserts). Anyway, I hope this helps
with the questions relating to the A- codes. If there are any further
questions call PFA
---
First, my apologies--between my browser and the world of Microsoft,
the HTML codes —, “, A” were inserted instead of hyphens in
my message--surely an ideal way to confound a coding issue if I ever saw one!
(although this did not affect all recipients of my message).
Second, it looks like my HCPCS book (published by the AMA press) is in
error when it (quite clearly) designates the three new A codes as
Noncovered. One is left to wonder how much other misinformation is out
there. You might want to keep that in mind if one of your physicians (or
more likely their MAs or PAs have taken time to peruse the AMA version of
reality) confronts you over what Medicare covers.
Here are the responses to date to my query concerning the replacements for
A5502:
As I read it, the only code that is not covered is
A5510. Since it is pressure molded as it is worn it
does not meet the Medicare standard of being total
contact at the time of delivery. The other two codes
are covered. The reimbursement rate stayed the same as
for last years A5502. My reading of the new regs was
validated this past week in a company wide coding
meeting.
Medicare only changed the definitions to better
reflect what the patient gets.
---
I think you are reading it wrong. Just the one code is no longer covered.
Go to www.pedorthics.org to see what the new regulations are.
---
What are the 8221 codes you are refering to?
The new A codes did to our knowledge eliminate the 5502, it was way to
abused.
The three new codes are 5509 - 11 and one of them which I can't remember at
this time, I thinks it's 5510 is basicly an insert just stuck in the shoe
with no premolding. This one is not going to be covered by Medicare
according to the AOPA in Advance notice that is. I'm at home, not in the
office and using my memory. Let me know if you have other questions.
---
Where did you get your new 2002 hspc book I beed one and would like to know
where I can purchase it..... also am concerned about the insole question and
would like to know as well if this is true .
---
As to your question on the A5509, 5510 and 5511 codes. It goes like this.
A5509 and A5510 are for prefabricated multi density diabetic insoles. Under
the A5509 code the device must be heated - either with a heat gun or in an
oven and pulled over a cast. Since you are dealing with Plastazote which is
very accomodative it is probably best to use a heat gun sparingly, and pull
over a cast in only the extreme cases. If you do this you will get reimbused
under 5509. If you bill under 5510 you will NOT get reimbursed. Even though
you can essentially accomplish the same as heating by letting the patient
mold the insoles via weight. A5511 is for custom insoles, not prefab.
---
We have been unsuccessful at collecting from Medicare on the A5509 which
should be the prefab FO. The A5511, however, is covered by Medicare for
Diabetics provided that they meet the criteria laid out by Medicare. (We
almost always do these anyway, I guess it is just because I don't feel good
about fitting off-the-shelf orthotics even if they are first heated in a
convection oven.) Medicare has paid us many times already over the past
month an a half for this code...Unfortunately, they still only pay about
$65.00 per pair. This sucks!!! At this rate, by the time I or one of my
Cpeds does an eval, listens to their ENTIRE medical history, fits them with
shoes, takes an impression or cast of their foot, makes the mold fabricates
the orthoses and sees them again for a fitting of the orthotics, we have
definitely lost money. One can rationalize that we will make it back on
other devices, but unless we want to turn these people away, or make them
pay out-of-pocket like most facilities do, we just have to take it. This is
a subject that we have had much discussion about in recent months, and are
considering these types of options. I would love to hear what the other
responses show. If you don't post them, please at least forward them to me.
Thanks.
----
Send me a Fax number and I'll share a copy of the AOPA in Advance with you.
It's my only resource on this issue at this point.
----
Harry, my comment on your post goes like this. In our Dmerc region D we were
told that A5509, A5510, A5511 are all set at $33.00. However, that is likely
to change soon because they are still trying to figure out the whole mess.
Codes —, “, A” are mystery codes to me. With an x as the
alpha the codes are medcaid codes. I forgot which ones were which but some
are not covered.
----
As a Pedorthist and a member of the PFA (Pedorthic footwear Association) I
have learned that the original insert code is still in use until March 2002.
The new codes are tricky. The code for prefabricated inserts is NOT covered.
The code for heat formed (heatgun etc.) prefabricated inserts are covered.
The code for custom molded inserts are covered. The catch is this, the
allowables are the same (around $60-65/pair) even for the custom molded
inserts. Three pairs/year are still allowed (or two pairs and a
modification). PFA is lobbying for Medicare to consider paying more for the
custom molded inserts ( a total of approx. $180-190/ pair) but reducing the
allowed amount to cover only one pair a year (which doesn't hurt the
government's budget because the price they are lobbying for is exactly the
same per year as three sets of the other inserts). Anyway, I hope this helps
with the questions relating to the A- codes. If there are any further
questions call PFA
---
Citation
“"A" Code Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed December 27, 2024, https://library.drfop.org/items/show/217992.
