MyMedi-AI

A5506 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe

HCPCS Level II A-code · short descriptor: “Diabetic shoe w/off set heel”

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
Status
Active (April 2026 HCPCS)

Prior authorization

Not on the Medicare required-PA list as of the January 13, 2026 update (74 items). 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 (April 13, 2026 update — 83 items). The standard written order must reach the supplier before claim submission.

Blank requirements checklist only — MyMedi-AI never collects or stores completed orders.

A5506 Medicare fee schedule (April 2026)

Base (no modifier) Therapeutic shoes

Medicare allowable: $45.79 in all listed states.

Former-CBA payment limits: ceiling $54.95 · floor $41.21

StateNon-ruralRural
AK$45.79
AL$45.79
AR$45.79
AZ$45.79
CA$45.79
CO$45.79
CT$45.79
DC$45.79
DE$45.79
FL$45.79
GA$45.79
HI$45.79
IA$45.79
ID$45.79
IL$45.79
IN$45.79
KS$45.79
KY$45.79
LA$45.79
MA$45.79
MD$45.79
ME$45.79
MI$45.79
MN$45.79
MO$45.79
MS$45.79
MT$45.79
NC$45.79
ND$45.79
NE$45.79
NH$45.79
NJ$45.79
NM$45.79
NV$45.79
NY$45.79
OH$45.79
OK$45.79
OR$45.79
PA$45.79
PR$45.79
RI$45.79
SC$45.79
SD$45.79
TN$45.79
TX$45.79
UT$45.79
VA$45.79
VI$45.79
VT$45.79
WA$45.79
WI$45.79
WV$45.79
WY$45.79
Amounts are the Medicare DMEPOS fee-schedule allowables effective April 2026. Medicare typically pays 80% of the allowable after the Part B deductible; the patient owes 20%. A 2% sequestration reduction applies to the Medicare share. Former competitive-bidding-area adjustments and non-continental rates can differ — verify with your DME MAC.

Common denial codes to watch

Related A-codes

Bill A5506 with confidence

MyMedi-AI scrubs whole claims against NCCI pairs, MUE limits, modifier rules, and PA flags before you submit — built for DME teams, no PHI stored on our servers.

Start free trial   Run a CMS-0057-F readiness check

Prefer DIY compliance? Self-audit documentation kits for DME suppliers →

Building an AI agent? Try the agent API in the playground — free PA-required lookups, A5506 included, and starter credits via POST /bot-marketplace/register.