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Diabetic
Shoe Bill
MEDICARE'S
THERAPEUTIC SHOEBILL
According
to the American Diabetes Association, there are approximately 16 million
Americans with diabetes. Unfortunately, this number continues to grow.
Twenty-five percent of persons with diabetes develop foot problems related to
the disease. Recognizing this problem, Congress approved the Medicare
Therapeutic Shoe Bill; helping thousands of persons with diabetes obtain
protective footwear and inserts.
Medicare
Beneficiary Eligibility
Medicare covers diabetic shoes, inserts and modifications for program
beneficiaries only if the following criteria are met:
(A) The Patient has diabetes and one or more of the following conditions:
---------- i) Previous amputation of the other foot, or part
of either foot, of
---------- ii) History of previous foot ulceration of either foot,
or
---------- iii) History of pre-ulcerative calluses of either foot,
or
---------- iv) Peripheral neuropathy with evidence of callus formation of
either foot, or
---------- v) Foot deformity of either foot, or
---------- vi) Poor circulation in either foot; and
(B)
The certifying physician who is managing the patient‘s systemic diabetes
condition has certified that
(1) one or more of the
indications required by (A) above are present,
(2) he or she is treating
the patient under a comprehensive plan of care for his
or her diabetes, and
(3) the patient needs
diabetic shoes, inserts or modifications.
What is
Covered?
Coverage
Limitations
For Medicare beneficiaries meeting criteria described above, coverage is limited
to one of the following within 1 calendar year:
1
pair of
off-the-shelf depth shoes and 3 additional pairs of multi-density inserts.
2
1 pair
of off-the-shelf depth shoes including a modification, and 2 additional pairs of
multi-density inserts.
3
1 pair
of custom-molded shoes and 2 additional pair of multi-density inserts.
Documentation
Requirements
Medicare program carriers generally require the following before reimbursement
will be made for shoes, inserts or modifications furnished to a program
beneficiary.
A
certification of medical necessity from the physician who manages the patient's
diabetes, which certifies that the patient
(a) has diabetes mellitus,
(b) has at least one of the qualifying conditions,
(c) is being treated under a comprehensive plan of care for his or her diabetes,
and
(d) needs diabetic shoes.
Medicare carriers recommend that suppliers use the Medicare approved
“Statement of Certifying Physician for Therapeutic Shoes” form to fulfill
this requirement.
A
prescription for a particular type of footwear (e.g., shoes, inserts,
modifications) from a podiatrist, or physician who is knowledgeable in the
fitting of diabetic shoes and inserts. Suppliers are required to keep file
copies of signed and dated physician prescriptions.
Furnishing
The Footwear
The footwear must be fitted and furnished by a podiatrist or other qualified
individual, such as a pedorthist, orthotist, or prosthetist. The certifying
physician may not furnish the footwear unless he or she practices in a defined
rural area or health professional shortage area. The prescribing physician may
be the supplier.
Additional Requirements
Additional requirements may apply. You should consult a qualified expert or
Medicare for more information.
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