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
- 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.
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 | — |
Common denial codes to watch
Related A-codes
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