A5513 — For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each
HCPCS Level II A-code · short descriptor: “Multi den insert custom mold”
- 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.
A5513 Medicare fee schedule (April 2026)
Base (no modifier) Therapeutic shoes
Medicare allowable: $55.16 in all listed states.
Former-CBA payment limits: ceiling $66.19 · floor $49.64
| State | Non-rural | Rural |
|---|---|---|
| AK | $55.16 | — |
| AL | $55.16 | — |
| AR | $55.16 | — |
| AZ | $55.16 | — |
| CA | $55.16 | — |
| CO | $55.16 | — |
| CT | $55.16 | — |
| DC | $55.16 | — |
| DE | $55.16 | — |
| FL | $55.16 | — |
| GA | $55.16 | — |
| HI | $55.16 | — |
| IA | $55.16 | — |
| ID | $55.16 | — |
| IL | $55.16 | — |
| IN | $55.16 | — |
| KS | $55.16 | — |
| KY | $55.16 | — |
| LA | $55.16 | — |
| MA | $55.16 | — |
| MD | $55.16 | — |
| ME | $55.16 | — |
| MI | $55.16 | — |
| MN | $55.16 | — |
| MO | $55.16 | — |
| MS | $55.16 | — |
| MT | $55.16 | — |
| NC | $55.16 | — |
| ND | $55.16 | — |
| NE | $55.16 | — |
| NH | $55.16 | — |
| NJ | $55.16 | — |
| NM | $55.16 | — |
| NV | $55.16 | — |
| NY | $55.16 | — |
| OH | $55.16 | — |
| OK | $55.16 | — |
| OR | $55.16 | — |
| PA | $55.16 | — |
| PR | $55.16 | — |
| RI | $55.16 | — |
| SC | $55.16 | — |
| SD | $55.16 | — |
| TN | $55.16 | — |
| TX | $55.16 | — |
| UT | $55.16 | — |
| VA | $55.16 | — |
| VI | $55.16 | — |
| VT | $55.16 | — |
| WA | $55.16 | — |
| WI | $55.16 | — |
| WV | $55.16 | — |
| WY | $55.16 | — |
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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