CommercialBilling CodesMedium impact
05.00.35g, Foot Orthotics and Other Podiatric Appliances
Independence Blue Cross·PA, NJ · Podiatry, Endocrinology, General Practice +1 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 05.00.35g to add ICD-10 diagnosis code E11.A (Type 2 diabetes with hyperglycemia) effective 10/01/2025. This aligns with the existing diabetic foot orthotic coverage for Pennsylvania and New Jersey mandates. Billing teams must verify member eligibility and ensure proper diagnosis coding for diabetic orthotic claims.
Action Required
By October 1, 2025: Billing team must update claim submission systems and EMR templates to recognize ICD-10 code E11.A for diabetic foot orthotic coverage determinations. Verify that claims for foot orthotics (HCPCS codes L3000-L3020, L3100, L3170, A9283) include diagnosis code E11.A when applicable for Pennsylvania and New Jersey commercial plan members. Confirm that L3100 and L3170 are coded as benefit exclusions in the billing system, while other L-codes remain medically necessary when properly diagnosed and prescribed. Train billing staff that foot orthotics are generally excluded except for diabetes-related cases in PA/NJ or per state mandates. Failure to properly apply the new diagnosis code may result in claim denials or payment delays.