INDUSTRYNEWS
DECEMBER 6, 2018: JANUARY 1, 2019:
DME MAC Joint Publication New information for 2019! The 2019 DMEPOS Fee
Schedule is available. You can download and new A5514
HCPCS coding information at the bottom of this page.
Facial Prostheses, Knee Orthosis (KO), Lower Limb Pros-
theses (LLP), Orthopedic Footwear, Refractive Lenses,
Surgical Dressings, Therapeutic Shoes for Persons with
Diabetes (TSD), and Wheelchair Options/Accessories
Policy Articles.
Effective for claims with dates of service (DOS) on or after
3/1/2019, suppliers must bill each item on two separate
claim lines using the RT and LT modifiers and 1 UOS on
each claim line. Do not use the combination RTLT modi-
fier on the same claim line and bill with 2 units of service
(UOS). Claim lines for HCPCS codes requiring use of the
RT and LT modifiers, billed without the RT and/or LT
modifiers or with the RTLT on a single claim line, will be
rejected as incorrect coding.
• Refer to the Ankle-Foot/Knee-Ankle-Foot Orthoses
(A52457External Website),
• External Breast Prostheses (A52478—External Website),
• Eye Prostheses (A52462—External Website),
• Facial Prostheses (A52463—External Website),
• Knee Orthoses (A52465—External Website),
• Lower Limb Prostheses (A52496—External Website),
• Orthopedic Footwear (A52481—External Website),
Items of interest:
• The 2019 Medicare deductible will be $185, which is a
$2 increase from 2018.
• K0903 will be replaced with code A5514 beginning on
claims with a date of service 1/1/19 and after.
• There is an increase in all the A-codes this year. Below
is a comparison list and attached is the Medicare fee
schedule for all DME codes.
2018
HCPCS Description per
unit
A5500 Diabetic shoe for density insert
2019
per pair per
unit per
pair
71.56 143.12 73.21 146.42
439.18
A5501 Diabetic custom molded shoe 214.65 429.30 219.59 A5503 Diabetic shoe with roller/rocker 35.27 70.54 36.24 72.48
A5504 Diabetic shoe with wedge 35.27 70.54 36.24 72.48
A5505 Diabetic shoe with metatarsal
bar 35.27 70.54 36.24 72.48
A5506 Diabetic shoe with offset heel 35.27 70.54 36.24 72.48
A5507 Modification diabetic shoe 35.27 70.54 36.24 72.48
A5512 Multi density insert heat
molded 29.19 58.38 29.86 59.72
A5513 Multi density insert custom
molded 43.56 87.12 44.56 89.12
A5514 Multi density insert, CAM
technology 43.56 87.12 44.56 89.12
• Refractive Lenses (A52499—External Website),
• Surgical Dressings (A54563—External Website),
• Therapeutic Shoes for Persons with Diabetes (A52501—
External Website) and
• Wheelchair Options/Accessories Policy Article
(A52504—External Website) and
• Standard Documentation Requirements Policy Article
(A55426—External Website) for additional coding and
documentation requirements.
Publication History
December 6, 2018 Original Publication
12
Pedorthic Footcare Association | www.pedorthics.org
Revised JANUARY 2019 - Fee Schedule
DOWNLOAD EXCEL SPREADSHEET
Please let us know if you have any questions!
Contact: [email protected]
Publication History
December 6, 2018 Original Publication