A5512 — For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each
HCPCS Level II A-code · short descriptor: “Multi den insert direct form”
- 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
- 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.
A5512 Medicare fee schedule (April 2026)
Base (no modifier) Therapeutic shoes
Medicare allowable: $36.96 in all listed states.
Former-CBA payment limits: ceiling $44.35 · floor $33.26
| State | Non-rural | Rural |
|---|---|---|
| AK | $36.96 | — |
| AL | $36.96 | — |
| AR | $36.96 | — |
| AZ | $36.96 | — |
| CA | $36.96 | — |
| CO | $36.96 | — |
| CT | $36.96 | — |
| DC | $36.96 | — |
| DE | $36.96 | — |
| FL | $36.96 | — |
| GA | $36.96 | — |
| HI | $36.96 | — |
| IA | $36.96 | — |
| ID | $36.96 | — |
| IL | $36.96 | — |
| IN | $36.96 | — |
| KS | $36.96 | — |
| KY | $36.96 | — |
| LA | $36.96 | — |
| MA | $36.96 | — |
| MD | $36.96 | — |
| ME | $36.96 | — |
| MI | $36.96 | — |
| MN | $36.96 | — |
| MO | $36.96 | — |
| MS | $36.96 | — |
| MT | $36.96 | — |
| NC | $36.96 | — |
| ND | $36.96 | — |
| NE | $36.96 | — |
| NH | $36.96 | — |
| NJ | $36.96 | — |
| NM | $36.96 | — |
| NV | $36.96 | — |
| NY | $36.96 | — |
| OH | $36.96 | — |
| OK | $36.96 | — |
| OR | $36.96 | — |
| PA | $36.96 | — |
| PR | $36.96 | — |
| RI | $36.96 | — |
| SC | $36.96 | — |
| SD | $36.96 | — |
| TN | $36.96 | — |
| TX | $36.96 | — |
| UT | $36.96 | — |
| VA | $36.96 | — |
| VI | $36.96 | — |
| VT | $36.96 | — |
| WA | $36.96 | — |
| WI | $36.96 | — |
| WV | $36.96 | — |
| WY | $36.96 | — |
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
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