BILLING
Medicare eligibility allows for the reimbursement of a pair of shoes (A5500) and three (3) pairs of inserts (either A5512 or A5514). When billing Medicare for reimbursement of Anodyne’s diabetic shoes, inserts, modifications and/or toe fillers, the following codes should be referenced:
*Note: Medicare reimburses for 80% of the total reimbursement. The Medicare fee schedules are linked here.
HCPCS | 2024 | 2023 | Increase ($) | Increase (%) |
A5500 per pair | $ 173.54 | $ 169.14 | $ 4.40 | 2.6% |
A5512 per pair | $ 70.78 | $ 68.98 | $ 1.80 | 2.6% |
A5514 per pair | $ 105.62 | $ 102.94 | $ 2.68 | 2.6% |
Shoes w/ 3 pairs of HM | $ 385.88 | $ 376.08 | $ 9.80 | 2.6% |
Shoes w/ 3 pairs of CI | $ 490.40 | $ 477.96 | $ 12.44 | 2.6% |
*Please note reimbursement on L codes will vary based on patient’s available coverage and associated health plan.
HCPCS | L3010 | L3020 | L5000 |
Ceiling | $ 488.42 | $ 556.10 | $ 789.62 |
Floor | $ 366.32 | $ 417.06 | $ 592.22 |
AL | $ 412.24 | $ 469.42 | $ 620.31 |
AR | $ 412.22 | $ 469.36 | $ 789.62 |
AZ | $ 400.28 | $ 455.66 | $ 704.40 |
CA | $ 400.28 | $ 455.66 | $ 704.40 |
CO | $ 414.52 | $ 471.98 | $ 592.22 |
CT | $ 400.28 | $ 455.66 | $ 592.22 |
DC | $ 400.28 | $ 455.66 | $ 653.27 |
DE | $ 400.28 | $ 455.66 | $ 653.27 |
FL | $ 412.24 | $ 469.42 | $ 620.31 |
GA | $ 412.24 | $ 469.42 | $ 620.31 |
IA | $ 408.08 | $ 464.60 | $ 618.66 |
ID | $ 400.28 | $ 455.66 | $ 592.22 |
IL | $ 409.98 | $ 466.90 | $ 675.65 |
IN | $ 409.98 | $ 466.90 | $ 675.65 |
KS | $ 408.08 | $ 464.60 | $ 618.66 |
KY | $ 412.24 | $ 469.42 | $ 620.31 |
LA | $ 412.22 | $ 469.36 | $ 789.62 |
MA | $ 400.28 | $ 455.66 | $ 592.22 |
MD | $ 400.28 | $ 455.66 | $ 653.27 |
ME | $ 400.28 | $ 455.66 | $ 592.22 |
MI | $ 409.98 | $ 466.90 | $ 675.65 |
MN | $ 409.98 | $ 466.90 | $ 675.65 |
MO | $ 408.08 | $ 464.60 | $ 618.66 |
MS | $ 412.24 | $ 469.42 | $ 620.31 |
MT | $ 414.52 | $ 471.98 | $ 592.22 |
NC | $ 412.24 | $ 469.42 | $ 620.31 |
ND | $ 414.52 | $ 471.98 | $ 592.22 |
NE | $ 408.08 | $ 464.60 | $ 618.66 |
NH | $ 400.28 | $ 455.66 | $ 592.22 |
NJ | $ 400.28 | $ 455.66 | $ 592.22 |
NM | $ 412.22 | $ 469.36 | $ 789.62 |
NV | $ 400.28 | $ 455.66 | $ 704.40 |
NY | $ 400.28 | $ 455.66 | $ 592.22 |
OH | $ 409.98 | $ 466.90 | $ 675.65 |
OK | $ 412.22 | $ 469.36 | $ 789.62 |
OR | $ 400.28 | $ 455.66 | $ 592.22 |
PA | $ 400.28 | $ 455.66 | $ 653.27 |
RI | $ 400.28 | $ 455.66 | $ 592.22 |
SC | $ 412.24 | $ 469.42 | $ 620.31 |
SD | $ 414.52 | $ 471.98 | $ 592.22 |
TN | $ 412.24 | $ 469.42 | $ 620.31 |
TX | $ 412.22 | $ 469.36 | $ 789.62 |
UT | $ 414.52 | $ 471.98 | $ 592.22 |
VA | $ 400.28 | $ 455.66 | $ 653.27 |
VT | $ 400.28 | $ 455.66 | $ 592.22 |
WA | $ 400.28 | $ 455.66 | $ 592.22 |
WI | $ 409.98 | $ 466.90 | $ 675.65 |
WV | $ 400.28 | $ 455.66 | $ 653.27 |
WY | $ 414.52 | $ 471.98 | $ 592.22 |
AK | $ 400.28 | $ 455.66 | $ 689.04 |
HI | $ 400.28 | $ 455.66 | $ 736.85 |
PR | $ 440.24 | $ 501.18 | $ 956.80 |
VI | $ 440.24 | $ 501.18 | $ 592.22 |
For a full list of billing codes and our suggested Medicare forms, visit our Resource Center. If you have any other questions, please do not hesitate to reach us at 1-844-637-4637 or email info@anodyneshoes.com