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2002 Region C DMEPOS Fee Schedule
Therapeutic Shoes
In July of 1994, a provision for the coverage of therapeutic shoes for individuals with diabetes was included in the Medicare Carriers Manual (Section 2134). In this provision, the Centers for Medicare and Medicaid Services (CMS) utlined limitations for reimbursement of therapeutic shoes. The 2002 payment limitations for diabetic shoe HCPCS codes follow.
As mandated by the Balanced Budget Refinement Act of 1999, the fee schedule for DME will be receiving a temporary increase of 0.6 percent for 2002. In accordance with § 1833 (o)(2) of the Social Security Act, this 0.6 percent temporary increase for 2002 also applies to the national payment limit for therapeutic shoes. Because this 0.6 percent increase applies only to 2002, it will not be carried over into future years (e.g., 2003, 2004).
Furthermore, as outlined in §§ 425 and 426 of the Benefits Improvement and Protection Act (BIPA) of 2000, the July 1, 2001 temporary update factors of 3.28 percent (which was applied to the fee schedules for DME, surgical dressings, ostomy supplies, tracheostomy supplies, and urologicals, and therapeutic shoe payment limits), and 2.6 percent (which was applied to prosthetics and orthotics) will not be carried over into 2002.
HCPCS Code | Pricing Limit | HCPCS Code | Pricing Limit |
A5500 | $ 66.00 | A5505 | $ 33.00 |
A5501 | $ 197.00 | A5506 | $ 33.00 |
A5502 | $ 33.00 | A5509 | $ 33.00 |
A5503 | $ 33.00 | A5511 | $ 33.00 |
A5504 | $ 33.00 |  | |
NOTE:The limitations to allowances listed may not reflect suppliers’ allowances. Medicare calculates the allowance for each HCPCS code listed above by selecting the lower of the prevailing charge, the supplier’s customary charge (or 50th percentile of customary charges in the absence of a customary charge), the inflation index charge, the CMS limit and the supplier’s submitted charge.
Suppliers may obtain a profile of their customary charges by writing to:
Palmetto GBA - Pricing Unit
P.O. Box 100190, AG-311
Columbia, S.C. 29202-3190
Suppliers should include their National Supplier Clearinghouse number on all requests. They should contact their Dedicated Work Team at (866) 238-9650 if they have questions.
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