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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