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Current CMS pricing and breakdown for Multi den insert direct form.
National Medicare Payment
$36.96
This fee schedule does not publish separate facility and non-facility rates for this code.
Effective Q3 2026
The amounts shown are the published national payments. Local payment can vary based on your specific Zip Code, GPCI adjustments, and site of service.
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
| Quarter | National Medicare Payment | YoY % Change |
|---|---|---|
| 2026 Q3 | $36.96 | +1.99% |
| 2026 Q2 | $36.96 | +1.99% |
| 2026 Q1 | $37.10 | +2.37% |
| 2025 Q4 | $36.24 | — |
| 2025 Q3 | $36.24 | — |
| 2025 Q2 | $36.24 | — |
| 2025 Q1 | $36.24 | — |
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
CPT code 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) had a 2026 Medicare non-facility reimbursement rate of $36.96. This reflects a 1.99% change from the prior year.
The 2026 National Medicare reimbursement estimate for A5512 is $36.96. Actual payment can vary by locality, setting, and claim specifics.
Description: For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with pa.... For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | ||
| Practice Expense (PE) | ||
| Malpractice (MP) | ||
| Total RVUs | 0.00 | 0.00 |
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Facility vs. non-facility pricing most commonly applies to physician services paid under the RVU-based Physician Fee Schedule. For A5512 (DMEPOS Equipment), the payment methodology may not include both facility and non-facility rates.
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
The 2026 National Average Medicare reimbursement rate for A5512 (DMEPOS Equipment) is $36.96. This rate is effective as of January 1, 2026.
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
Facility vs. non-facility differences usually apply to RVU-based physician services. A5512 may not use both facility and non-facility pricing depending on its payment methodology.
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.