Requirements for coverage of diabetic shoes:

You must have an in person visit with your primary care doctor to discuss your diabetes care and review the condition of your feet. I will need chart notes from this that describes the specific reason therapeutic footwear is medically required, and which indicates the doctor is managing your diabetic care. The detailed description in the notes should correspond to the condition indicated on the certification form. The chart notes are only valid if your primary caregiver is a doctor(M.D. or D.O.) They are not acceptable if from any other health care professional!

In addition to the chart notes, I will need a signed prescription and certification form which I can provide prior to your appointment. Do not send these forms or drop them off at your doctors office, take them with you to your appointment. They are only valid if signed during or after the in person visit.

 If your primary care provider is not a doctor, or you do not have adequate documentation, you will be responsible for payment of services.

Tom Merriam, C.Ped.

 

therapeutic shoes for diabetics--physician requirements

An M.D. or D.O. (termed the “certifying physician”)
must be managing the patient's diabetes under a comprehensive plan
of care and must certify that the patient needs therapeutic shoes.
The certifying physician must document that the patient has one or
more of the following qualifying conditions:

  • Foot deformity

  • Current or previous foot ulceration

  • Current or previous pre-ulcerative calluses

  • Previous partial amputation of one or both feet or complete
    amputation of one foot

  • Peripheral neuropathy with evidence of callus formation

  • Poor circulation

According to Medicare national policy, it is not sufficient for
a podiatrist, physician assistant (PA), nurse practitioner (NP), or
clinical nurse specialist (CNS) to provide that documentation
(although they are permitted to sign the order for the shoes and
inserts). The certifying physician must be an M.D. or D.O.

The following physician documentation is required in
order for Medicare to pay for therapeutic shoes and inserts and
must be provided by the physician to the supplier, if
requested:

  1. A detailed written order.

  2. A copy of an office visit note from the patient's medical
    records that shows the physician is managing the patient's
    diabetes. This note should be within six months prior to delivery
    of the shoes and inserts.

  3. Either (a) a copy of an office visit note from the physician's
    medical records that describes one of the qualifying conditions or
    (b) an office visit note from another physician (e.g., podiatrist)
    or from a PA, NP or CNS that describes one of the qualifying
    conditions. If option (b) is used, the certifying physician must
    sign, date and make a note on that document indicating their
    agreement and send that to the supplier.

    The note documenting the qualifying condition(s) must be more
    detailed than the general descriptions that are listed above. It
    must describe (examples not all-inclusive):

    • The specific foot deformity (e.g., bunion, hammer toe, etc.);
      or

    • The location of a foot ulcer or callus or a history of one these
      conditions; or

    • The type of foot amputation; or

    • Symptoms, signs, or tests supporting a diagnosis of peripheral
      neuropathy plus the presence of a callus; or

    • The specifics about poor circulation in the feet, e.g., a
      diagnosis of venous or arterial insufficiency or symptoms, signs,
      or test documenting one of these diagnoses. A diagnosis of
      hypertension, coronary artery disease, or congestive heart failure
      or the presence of edema are not by themselves sufficient.

  4. A certification form stating that the coverage criteria
    described have been met. However, this form is not sufficient by
    itself and must be supported by other documents in the certifying
    physician's medical records as noted in items 2 and 3.

New documentation from the patient medical record is required
annually in order for Medicare to pay for replacement shoes and
inserts.