Local Coverage Determination · DME MAC
L33369
Therapeutic Shoes for Persons with Diabetes
Version 26. CMS effective date 01/01/2020. CMS updated 02/28/2020. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. Medicare Benefit Policy Manual (IOM 100-02), Chapter 15, Section 140
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. The statutory coverage criteria for therapeutic shoes including the requirement for an order are specified in the related Policy Article. Separate inserts may be covered and dispensed independently of diabetic shoes if the supplier of the shoes verifies in writing that the beneficiary has appropriate footwear into which the insert can be placed. This footwear must meet the definitions found in this policy for depth shoes or custom-molded shoes. A custom molded shoe (A5501) is covered when the beneficiary has a foot deformity that cannot be accommodated by a depth shoe. The nature and severity of the deformity must be well documented in the supplier's records and available upon request.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A52501 · Therapeutic Shoes for Persons with Diabetes - Policy Article
HCPCS codes on this LCD
10 other Level II codes are on the LCD and are not given a page in this set: A5503, A5504, A5505, A5506, A5507, A5508, A5510, A5512, A5513, A5514.
Questions
What does LCD L33369 cover?
L33369 is Therapeutic Shoes for Persons with Diabetes. It is a current final DME MAC local coverage determination, version 26.
Where is the CMS source for L33369?
The Medicare Coverage Database page for LCD L33369 version 26.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=A5500&as_of=2024-01-15&npi=1234567890&state=UT"