| Field Name |
Field Value |
| Healthcare Common Procedure Coding System Code |
A5510 |
| HCPCS Sequence Number |
0010 |
| HCPCS Record Identification Code |
3 - First line of procedure record also contains detail information in positions 92-275 |
| HCPCS Long Description |
For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe |
| HCPCS Short Description |
Compression form shoe insert |
| HCPCS Pricing Indicator Code 1 |
38 - Orthotics, prosthetics, prosthetic devices & vision services (price subject to floors and ceilings) |
| HCPCS Multiple Pricing Indicator Code |
A - Not applicable as HCPCS priced under one methodology |
| HCPCS Medicare Carriers Manual Reference Section Number 1 |
2134 |
| HCPCS Coverage Code |
D - Special coverage instructions apply |
| HCPCS Berenson-Eggers Type Of Service Code |
D1F - Prosthetic/Orthotic devices |
| HCPCS Type Of Service Code 1 |
J - Diabetic shoes (eff 04/95) |
| HCPCS Anesthesia Base Unit Quantity |
0 |
| HCPCS Code Added Date |
1/1/2002 |
| HCPCS Action Effective Date |
1/1/2005 |
| HCPCS Action Code |
N - No maintenance for this code |