According to the American Diabetes Association, there are approximately 16 million Americans living with diabetes. Unfortunately, this number continues to grow. Twenty-five percent of persons with diabetes develop foot problems related to the disease. Fortunately, the Medicare Therapeutic Shoe Bill helps thousands upon thousands of Americans obtain protective footwear, such as diabetic socks, shoes, and inserts to help alleviate their symptoms. Here at New Hope Prosthetics and Orthotics, we are participating providers for this program, as well as its private insurance and Medicaid variations. This program is federally funded, and it can often be confusing for our patients. That’s why we want to help you understand how it works and what it can do for you.
Medicare and most insurance policies cover diabetic shoes, inserts, and other modifications for program beneficiaries only if the following criteria are met:
The patient has diabetes and one or more of the following conditions: previous amputation of either foot (or part of either foot); history of previous foot ulceration of either foot; history of pre-ulcerative calluses of either foot; peripheral neuropathy with evidence of callus formation of either foot; deformity of either foot; poor circulation in either foot.
The certifying physician who is managing the patient’s systemic diabetic condition has certified that: one or more of the indications required by the above are present; he or she is treating the patient under a comprehensive plan of care for his or her diabetes; the patient needs diabetic shoes, inserts, or modifications.
If either requirement above is met, then you may qualify for diabetic shoes at little or no out-of-pocket expense.
For Medicare beneficiaries meeting the criteria, coverage is limited to one of the following within one calendar year:
- One pair of off-the-shelf depth shoes and three additional pairs of multi-density inserts
- One pair of off-the-shelf depth shoes with a modification and two additional pairs of multi-density inserts
- One pair of custom-molded shoes and two additional pairs of multi-density inserts
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 has diabetes mellitus, has at least one of the qualifying conditions, is being treated under a comprehensive plan of care for his or her diabetes, and 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 with the knowledge and ability to identify and make needed alterations to the shoe and/or insole.
Do you need diabetic shoes in Little Rock, AR? New Hope Prosthetics & Orthotics can help. Please contact us today to make an appointment!