Diabetics Shoes/Inserts

Dr. Comfort Mt. Emey p.w. minor Propet 

We at New Hope Prosthetics and Orthotics, we offer a full line of both off-the-shelf and custom diabetic shoes and inserts. We are participating providers for the Medicare Therapeutic Shoe Program and also provide shoes under many private insurance programs.  Diabetic shoes have come a long way in the past few years.  They are lighter, stylish, and have more variety than ever before.  We carry many styles from a variety of quality manufacturers.

Custom Shoes

We also work in conjunction with various custom shoe manufacturers to design custom made shoes for difficult to fit feet.  These are commonly used when there is a deformity, brace or severe swelling to accommodate 

 

How Much Do Diabetic Shoes and Inserts Cost?

Diabetic shoes and inserts are covered under Medicare, Medicaid, and most insurance policies as long as certain criteria are met and your physician completes a therapeutic shoe form (you can print one below).

Medicare and most private insurances operate on the same system of payment.

If you have met your deductible and qualify for shoes, Medicare will pay 80% of the cost of the shoes and inserts.  For example, if your shoes and inserts cost a total of $300.00, then your out of pocket cost would be roughly $60.00.  

If you have Medicare and a secondary insurance (including Medicaid) and have met your deductible for the year then the shoes and inserts will be paid in full and you will have no balance due.  $0.00

Please understand, the total cost of the shoes and insoles includes:

  • Diabetic Shoes and insoles
  • Foot evaluation, sizing, and insole design
  • Fitting and adjustment 
  • Any follow-up appointments needed for adjustment

As Medicare providers, we at New Hope adhere strictly to the guidelines set forth in the Therapeutic (Diabetic) Shoe Program, please understand that just because you have been diagnosed with diabetes, this alone will not automatically qualify you for shoes.

 

What you need to know about Medicare’s Shoe Program

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, in 1993 Congress approved the Medicare Therapeutic Shoe Bill, helping thousands of persons with diabetes obtain protective footwear and inserts. We at New Hope are participating providers for this program as well as it’s private insurance and Medicaid variations. This program is a federal program and thus may seem a bit confusing and full of hoops to jump through.  If you have any questions please feel free to contact one of our staff for more information. 

Medicare/Insurance Beneficiary Eligibility

Medicare and most insurance policies cover 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:

  • Previous amputation of the other 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

(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.

If the requirements of both (a) and (b) are met, then you may qualify for diabetic shoes at little or no out of pocket expense.

 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. or
  • 1 pair of off-the-shelf depth shoes with a modification, and 2 additional pairs of multi-density inserts, or
  • 1 pair of custom-molded shoes and 2 additional pairs 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 individuals, such as a podiatrist, orthopedist, or prosthetist with the knowledge and ability to identify and make the needed alterations to the shoe and or insole.