Program Eligibility

Medicare covers diabetic shoes, inserts and modifications for Medicare 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, or

• History of previous foot ulceration of either foot, or

• History of pre-ulcerative calluses of either foot, or

• Peripheral neuropathy with evidence of callus formation of either foot, or

• Foot deformity of either foot, or

• 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,

(3) The patient needs diabetic shoes, inserts or modifications.

 

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.

• 1 pair of off-the-shelf depth shoes including a modification, and 2 additional pairs of multi-density inserts.

• 1 pair of custom-molded shoes and 2 additional pair of multi-density inserts.

 

Documentation Requirements

The following documentation requirements must be met 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.

• 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.

• Clinical Records provided by the Certifying Physician (who must be an MD or DO) documenting that an in-person visit occurred within 6 months prior to the delivery of the shoes or inserts, and detailing the evaluation of the eligibility requirements above have been met, or the indication of agreement (signified by initialing and dating) with information from the medical records of an in-person visit with a podiatrist, another M.D or D.O., physician assistant, nurse practitioner, or clinical nurse specialist that is within 6 months prior to delivery of the shoes/inserts. 

 

ABC Prosthetics & Orthotics has developed the following documentation packet for patients to bring to their physician treating their diabetes for completion prior to their Initial Evaluation for shoes and/or inserts.  If you have any questions regarding this documentation, please feel free to contact one of our Patient Care Coordinators for further assistance.

 

Click here to download Medicare Documentation
Forms for Therapeutic Shoes for Diabetics