A5504 HCPCS code: For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe
A5504 is the HCPCS Level II code for for diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe. The 2026 Medicare DMEPOS fee schedule pays $45.79 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Its average fee ranks 3 of 10 A55 codes (family range $36.96–$271.80).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1995-01-01 |
| Last action effective | 2005-01-01 |
2026 Medicare DMEPOS fee schedule for A5504
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $45.79 | $45.79 | $54.95 | $41.21 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $45.79 | — |
| AL | — | $45.79 | — |
| AR | — | $45.79 | — |
| AZ | — | $45.79 | — |
| CA | — | $45.79 | — |
| CO | — | $45.79 | — |
| CT | — | $45.79 | — |
| DC | — | $45.79 | — |
| DE | — | $45.79 | — |
| FL | — | $45.79 | — |
| GA | — | $45.79 | — |
| HI | — | $45.79 | — |
| IA | — | $45.79 | — |
| ID | — | $45.79 | — |
| IL | — | $45.79 | — |
| IN | — | $45.79 | — |
| KS | — | $45.79 | — |
| KY | — | $45.79 | — |
| LA | — | $45.79 | — |
| MA | — | $45.79 | — |
| MD | — | $45.79 | — |
| ME | — | $45.79 | — |
| MI | — | $45.79 | — |
| MN | — | $45.79 | — |
| MO | — | $45.79 | — |
| MS | — | $45.79 | — |
| MT | — | $45.79 | — |
| NC | — | $45.79 | — |
| ND | — | $45.79 | — |
| NE | — | $45.79 | — |
| NH | — | $45.79 | — |
| NJ | — | $45.79 | — |
| NM | — | $45.79 | — |
| NV | — | $45.79 | — |
| NY | — | $45.79 | — |
| OH | — | $45.79 | — |
| OK | — | $45.79 | — |
| OR | — | $45.79 | — |
| PA | — | $45.79 | — |
| PR | — | $45.79 | — |
| RI | — | $45.79 | — |
| SC | — | $45.79 | — |
| SD | — | $45.79 | — |
| TN | — | $45.79 | — |
| TX | — | $45.79 | — |
| UT | — | $45.79 | — |
| VA | — | $45.79 | — |
| VI | — | $45.79 | — |
| VT | — | $45.79 | — |
| WA | — | $45.79 | — |
| WI | — | $45.79 | — |
| WV | — | $45.79 | — |
| WY | — | $45.79 | — |
How the A5504 fee compares
| Measure | Value |
|---|---|
| Rank among 10 A55 codes (lowest = 1) | 3 |
| Family fee range (average of state fees) | $36.96–$271.80 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Published Contractor Policy |
What changed for A5504
- 2026-01-01: Average state fee rose 1.2%: $45.26 to $45.79
- 1995-01-01: A5504 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A5504?
A5504 is the HCPCS Level II code for for diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe. Short descriptor: "Diabetic shoe with wedge".
How much does Medicare pay for A5504?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $45.79. Rural fees can be higher.
Does Medicare cover A5504?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Did the Medicare fee for A5504 change in 2026?
The average non-rural state fee moved from $45.26 in 2025 to $45.79 in 2026 (+1.2%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5504 can be billed per day?
2 on DME suppliers (NCCI medically unlikely edits).
Related A55 codes
- A5500 — For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe ($90.63–$90.63)
- A5501 — For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe ($271.80–$271.80)
- A5503 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe ($45.79–$45.79)
- A5505 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe ($45.79–$45.79)
- A5506 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe ($45.79–$45.79)
- A5507 — For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe ($45.79–$45.79)
- A5508 — For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
- A5510 — For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe
- A5512 — For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each ($36.96–$36.96)
- 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 ($55.16–$55.16)
- A5514 — For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, 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 ($55.16–$55.16)
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Next steps
- Run a reimbursement report for a device billed under A5504
- Watch A5504 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A5504
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.