A5513 HCPCS code: 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
A5513 is the HCPCS Level II code for 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. The 2026 Medicare DMEPOS fee schedule pays $55.16 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 6 per day on DME suppliers. Medicare volume fell 26% from 2022 to 2024 (346,994 to 256,912 services). In 2024, 2,878 suppliers billed Medicare for A5513 (purchases), serving 47,230 beneficiaries; California, Florida, Pennsylvania accounted for 28% of services. Its average fee ranks 7 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 | 2006-01-01 |
| Last action effective | 2019-01-01 |
2026 Medicare DMEPOS fee schedule for A5513
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $55.16 | $55.16 | $66.19 | $49.64 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $55.16 | — |
| AL | — | $55.16 | — |
| AR | — | $55.16 | — |
| AZ | — | $55.16 | — |
| CA | — | $55.16 | — |
| CO | — | $55.16 | — |
| CT | — | $55.16 | — |
| DC | — | $55.16 | — |
| DE | — | $55.16 | — |
| FL | — | $55.16 | — |
| GA | — | $55.16 | — |
| HI | — | $55.16 | — |
| IA | — | $55.16 | — |
| ID | — | $55.16 | — |
| IL | — | $55.16 | — |
| IN | — | $55.16 | — |
| KS | — | $55.16 | — |
| KY | — | $55.16 | — |
| LA | — | $55.16 | — |
| MA | — | $55.16 | — |
| MD | — | $55.16 | — |
| ME | — | $55.16 | — |
| MI | — | $55.16 | — |
| MN | — | $55.16 | — |
| MO | — | $55.16 | — |
| MS | — | $55.16 | — |
| MT | — | $55.16 | — |
| NC | — | $55.16 | — |
| ND | — | $55.16 | — |
| NE | — | $55.16 | — |
| NH | — | $55.16 | — |
| NJ | — | $55.16 | — |
| NM | — | $55.16 | — |
| NV | — | $55.16 | — |
| NY | — | $55.16 | — |
| OH | — | $55.16 | — |
| OK | — | $55.16 | — |
| OR | — | $55.16 | — |
| PA | — | $55.16 | — |
| PR | — | $55.16 | — |
| RI | — | $55.16 | — |
| SC | — | $55.16 | — |
| SD | — | $55.16 | — |
| TN | — | $55.16 | — |
| TX | — | $55.16 | — |
| UT | — | $55.16 | — |
| VA | — | $55.16 | — |
| VI | — | $55.16 | — |
| VT | — | $55.16 | — |
| WA | — | $55.16 | — |
| WI | — | $55.16 | — |
| WV | — | $55.16 | — |
| WY | — | $55.16 | — |
How the A5513 fee compares
| Measure | Value |
|---|---|
| Rank among 10 A55 codes (lowest = 1) | 7 |
| Family fee range (average of state fees) | $36.96–$271.80 |
| Rural fee uplift | — |
Who bills A5513 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 2,878 |
| Referring clinicians | 19,866 |
| Medicare beneficiaries | 47,230 |
| States with claims | 50 |
| Share of services in top 3 states (California, Florida, Pennsylvania) | 28% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 3,821 | 64,344 |
| 2023 | 3,382 | 54,070 |
| 2024 | 2,878 | 47,230 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5513, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 346,994 | 64,344 | $47.07 | $36.62 |
| 2023 | 292,117 | 54,070 | $50.93 | $39.44 |
| 2024 | 256,912 | 47,230 | $52.34 | $40.59 |
States with the most A5513 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 35,652 | $40.83 |
| Florida | 21,508 | $41.02 |
| Pennsylvania | 14,073 | $40.76 |
| Ohio | 12,940 | $40.86 |
| Indiana | 12,865 | $40.99 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 6 | CMS Policy |
Medicare policy articles for this code
- A52457: Ankle-Foot/Knee-Ankle-Foot Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52501: Therapeutic Shoes for Persons with Diabetes - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (436 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | 2 |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | 2 |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | 2 |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | 2 |
| A52.16 | Charcot's arthropathy (tabetic) | 1 |
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | 1 |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | 1 |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | 1 |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | 1 |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | 1 |
Showing 10 of 436. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A5513
- 2026-01-01: Average state fee rose 2.0%: $54.08 to $55.16
- 2006-01-01: A5513 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 A5513?
A5513 is the HCPCS Level II code for 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. Short descriptor: "Multi den insert custom mold".
How much does Medicare pay for A5513?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $55.16. Rural fees can be higher.
Does Medicare cover A5513?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A5513?
Medicare policy articles that cite A5513 list 436 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.610 (Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy), E09.610 (Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy), E10.610 (Type 1 diabetes mellitus with diabetic neuropathic arthropathy). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A5513 change in 2026?
The average non-rural state fee moved from $54.08 in 2025 to $55.16 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5513 can be billed per day?
6 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)
- A5504 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), 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)
- 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 A5513
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- Build a full Medicare revenue model for A5513
Sources: CMS HCPCS Level II release October 2026; 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.