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
- MUE unit limit
- 6
- 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 2026-10-16; 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 2026-10-16; 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.
A5512 Medicare fee schedule (October 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 | — |
Unit limit (MUE)
Medicare's Medically Unlikely Edit caps A5512 at 6 units per date of service (absolute). Units above the MUE deny — typically as CO-151. Rationale: CMS Policy.
Common denial codes to watch
Related A-codes
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