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 | 2023 | Increase | 2022 | Increase | 2021 |
A5500 per pair | $ 169.14 | $ 13.54 | $ 155.60 | $ 7.56 | $ 148.04 |
A5512 per pair | $ 68.98 | $ 5.52 | $ 63.46 | $ 3.08 | $ 60.38 |
A5514 per pair | $ 102.94 | $ 8.24 | $ 94.70 | $ 4.60 | $ 90.10 |
|
|
|
|
|
|
Shoes w/ 3 pairs of HM | $ 376.08 | $ 30.10 | $ 345.98 | $ 16.80 | $ 329.18 |
Shoes w/ 3 pairs of CI | $ 477.96 | $ 38.26 | $ 439.70 | $ 21.36 | $ 418.34 |
*Please note reimbursement on L codes will vary based on patient’s available coverage and associated health plan.
HCPCS | L3010 | L3020 | L5000 |
Ceiling | $ 476.06 | $ 542.00 | $ 769.61 |
Floor | $ 357.04 | $ 406.50 | $ 577.21 |
AL | $ 401.80 | $ 457.52 | $ 604.59 |
AR | $ 401.78 | $ 457.46 | $ 769.61 |
AZ | $ 390.14 | $ 444.12 | $ 686.55 |
CA | $ 390.14 | $ 444.12 | $ 686.55 |
CO | $ 404.02 | $ 460.02 | $ 577.21 |
CT | $ 390.14 | $ 444.12 | $ 577.21 |
DC | $ 390.14 | $ 444.12 | $ 636.72 |
DE | $ 390.14 | $ 444.12 | $ 636.72 |
FL | $ 401.80 | $ 457.52 | $ 604.59 |
GA | $ 401.80 | $ 457.52 | $ 604.59 |
IA | $ 397.74 | $ 452.82 | $ 602.98 |
ID | $ 390.14 | $ 444.12 | $ 577.21 |
IL | $ 399.60 | $ 455.06 | $ 658.53 |
IN | $ 399.60 | $ 455.06 | $ 658.53 |
KS | $ 397.74 | $ 452.82 | $ 602.98 |
KY | $ 401.80 | $ 457.52 | $ 604.59 |
LA | $ 401.78 | $ 457.46 | $ 769.61 |
MA | $ 390.14 | $ 444.12 | $ 577.21 |
MD | $ 390.14 | $ 444.12 | $ 636.72 |
ME | $ 390.14 | $ 444.12 | $ 577.21 |
MI | $ 399.60 | $ 455.06 | $ 658.53 |
MN | $ 399.60 | $ 455.06 | $ 658.53 |
MO | $ 397.74 | $ 452.82 | $ 602.98 |
MS | $ 401.80 | $ 457.52 | $ 604.59 |
MT | $ 404.02 | $ 460.02 | $ 577.21 |
NC | $ 401.80 | $ 457.52 | $ 604.59 |
ND | $ 404.02 | $ 460.02 | $ 577.21 |
NE | $ 397.74 | $ 452.82 | $ 602.98 |
NH | $ 390.14 | $ 444.12 | $ 577.21 |
NJ | $ 390.14 | $ 444.12 | $ 577.21 |
NM | $ 401.78 | $ 457.46 | $ 769.61 |
NV | $ 390.14 | $ 444.12 | $ 686.55 |
NY | $ 390.14 | $ 444.12 | $ 577.21 |
OH | $ 399.60 | $ 455.06 | $ 658.53 |
OK | $ 401.78 | $ 457.46 | $ 769.61 |
OR | $ 390.14 | $ 444.12 | $ 577.21 |
PA | $ 390.14 | $ 444.12 | $ 636.72 |
RI | $ 390.14 | $ 444.12 | $ 577.21 |
SC | $ 401.80 | $ 457.52 | $ 604.59 |
SD | $ 404.02 | $ 460.02 | $ 577.21 |
TN | $ 401.80 | $ 457.52 | $ 604.59 |
TX | $ 401.78 | $ 457.46 | $ 769.61 |
UT | $ 404.02 | $ 460.02 | $ 577.21 |
VA | $ 390.14 | $ 444.12 | $ 636.72 |
VT | $ 390.14 | $ 444.12 | $ 577.21 |
WA | $ 390.14 | $ 444.12 | $ 577.21 |
WI | $ 399.60 | $ 455.06 | $ 658.53 |
WV | $ 390.14 | $ 444.12 | $ 636.72 |
WY | $ 404.02 | $ 460.02 | $ 577.21 |
AK | $ 390.14 | $ 444.12 | $ 671.58 |
HI | $ 390.14 | $ 444.12 | $ 718.18 |
PR | $ 429.08 | $ 488.48 | $ 932.55 |
VI | $ 429.08 | $ 488.48 | $ 577.21 |
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