Medicare is now differentiating between custom diabetic inserts fabricated by direct milling and those made by custom molding. Medicare requires that custom diabetic inserts made by CAD / CAM direct milling be billed using new code A5514 when dispensed, replacing K0903, effective January 1, 2019. Inserts provided by SafeStep are made in this way. If SafeStep does your billing, everything will be taken care of for you. If you submit claims yourself or via a billing service, be sure to start using the new custom insert code, A5514.
Both methods of manufacturing result in equivalent final products; reimbursement is also the same, $89.12 per pair, $267.36 for three pairs. Medicare is requiring manufacturers to submit custom diabetic inserts to PDAC for verification and has communicated that custom inserts need not be listed on the PDAC website, dmepdac.com.
If you have any questions, concerns or suggestions, please call our office at 866.712.STEP.