12/03/2024

Modifier with Diabetic Shoes

We have been getting denials for diabetic shoes (A5500) due to "inconsistent mod used or required mod missing". What should the modifiers be?

This answer can differ based on the payer. For Medicare Part B beneficiaries, guidance on Modifier use for this service is provided in the DME MAC Policy Article, "Therapeutic Shoes for Persons With Diabetes":

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52501&ContrID=140

It states the KX Modifier should be added to all shoes and inserts provided under the Therapeutic Shoes for Persons With Diabetes benefit if all of the extensive documentation and compliance guidelines are met.

As an NYSPMA and APMA member, you have access to excellent guidance regarding participation in the Medicare "Therapeutic Shoes for Persons With Diabetes" program. This guidance was developed in conjunction with PICA and is available to members here: https://www.apma.org/practice-management/reimbursement-resources/dme-physician-supplier/documentation-guidelines-for-the-medicare-therapeutic-shoe-program/

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA

Certified Professional Coder

Certified Professional Medical Auditor

Lehrman Consulting, LLC

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12/03/2024

Modifier with Diabetic Shoes