A5501 — For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe
HCPCS Level II A-code · short descriptor: “Diabetic custom molded shoe”
- Code system
- HCPCS Level II
- Family
- A — Medical & surgical supplies, ambulance
- Medicare coverage status
- Special coverage instructions apply
- DMEPOS payment category
- Therapeutic shoes
- Prior authorization
- Not on Medicare required-PA list
- Face-to-face & WOPD
- Not on the required list
- MUE unit limit
- 2
- Status
- Active (HCPCS Level II October 2026)
Prior authorization
Not on the Medicare required-PA list (CMS Required Prior Authorization List — 74 items in force on 2026-10-25; 8 more from 2026-10-28; sources: CMS list updated 2026-01-13, CMS-6109-N (91 FR 47972)). Medicare Advantage and commercial plans set their own prior-authorization rules for this code — verify per plan before delivery.
Order readiness — what the written order must contain
Every Medicare DMEPOS claim needs a Standard Written Order with all six elements (42 CFR 410.38(d)):
- Beneficiary name or Medicare Beneficiary Identifier (MBI) (42 CFR 410.38(d)(1)(i)(A))
- General description of the item (42 CFR 410.38(d)(1)(i)(B))
- Quantity to be dispensed, if applicable (42 CFR 410.38(d)(1)(i)(C))
- Order date (42 CFR 410.38(d)(1)(i)(D))
- Treating practitioner name or NPI (42 CFR 410.38(d)(1)(i)(E))
- Treating practitioner signature (42 CFR 410.38(d)(1)(i)(F))
Not on the F2F/WOPD list (CMS Required F2F & WOPD List — 83 items in force on 2026-10-25; 22 more from 2026-10-28; sources: CMS list effective 2026-04-13 (91 FR 1250), CMS-6109-N (91 FR 47972)). The standard written order must reach the supplier before claim submission.
Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.
A5501 Medicare fee schedule (October 2026)
Base (no modifier) Therapeutic shoes
Medicare allowable: $271.80 in all listed states.
Former-CBA payment limits: ceiling $326.16 · floor $244.62
| State | Non-rural | Rural |
|---|---|---|
| AK | $271.80 | — |
| AL | $271.80 | — |
| AR | $271.80 | — |
| AZ | $271.80 | — |
| CA | $271.80 | — |
| CO | $271.80 | — |
| CT | $271.80 | — |
| DC | $271.80 | — |
| DE | $271.80 | — |
| FL | $271.80 | — |
| GA | $271.80 | — |
| HI | $271.80 | — |
| IA | $271.80 | — |
| ID | $271.80 | — |
| IL | $271.80 | — |
| IN | $271.80 | — |
| KS | $271.80 | — |
| KY | $271.80 | — |
| LA | $271.80 | — |
| MA | $271.80 | — |
| MD | $271.80 | — |
| ME | $271.80 | — |
| MI | $271.80 | — |
| MN | $271.80 | — |
| MO | $271.80 | — |
| MS | $271.80 | — |
| MT | $271.80 | — |
| NC | $271.80 | — |
| ND | $271.80 | — |
| NE | $271.80 | — |
| NH | $271.80 | — |
| NJ | $271.80 | — |
| NM | $271.80 | — |
| NV | $271.80 | — |
| NY | $271.80 | — |
| OH | $271.80 | — |
| OK | $271.80 | — |
| OR | $271.80 | — |
| PA | $271.80 | — |
| PR | $271.80 | — |
| RI | $271.80 | — |
| SC | $271.80 | — |
| SD | $271.80 | — |
| TN | $271.80 | — |
| TX | $271.80 | — |
| UT | $271.80 | — |
| VA | $271.80 | — |
| VI | $271.80 | — |
| VT | $271.80 | — |
| WA | $271.80 | — |
| WI | $271.80 | — |
| WV | $271.80 | — |
| WY | $271.80 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps A5501 at 2 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: Published Contractor Policy.
Common denial codes to watch
Related A-codes
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