Why is the Therapeutic Shoe Bill right for you?
With the passing of the Therapeutic Shoe Bill, Medicare (Part B) extended coverage to diabetic patients for footwear and foot inserts such as Ambulator® Biomechanical & Conform Footwear and Anti-Shox® Conform Orthotics. This protective footwear can help in the fight to prevent the 54,000 diabetic amputations that occur each year.
Medicare covers diabetic patients for one pair of extra-depth shoes and three pair of multi-density inserts per year.
What is covered?
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.
What is reimbursed?
Eighty percent of the amount designated as the “allowable” will be reimbursed. This amount may vary from state to state. The amount reimbursed by Medicare will go either to the supplier (if the supplier accepts assignment) or to the patient (if the supplier does not accept assignment). If the supplier does not accept assignment, the patient is usually expected to pay in full, prior to receiving any Medicare reimbursement.
What is the statement of Certifying Physician?
The physician who is managing the patient’s systemic diabetic condition must submit a statement of certifying physician for therapeutic shoes with the following suggested format:
- “I certify that all of the following statements are true”:
- This patient has diabetes mellitus
- This patient has one or more of the following conditions:
I am treating this patient under a comprehensive plan of care for his/her diabetes.
This patient needs special shoes and/or inserts because of his/her diabetes.
- History of partial or complete amputation of the foot.
- History of previous foot ulceration.
- History of pre-ulcerative callus formation.
- Peripheral neuropathy with evidence of callus formation.
- Foot deformity
- Poor circulation
This statement can be prepared by the prescriber or supplier, but must be reviewed and signed by the certifying physician. The certifying physician must be an M.D. or D.O., and not a podiatrist.
Click here to print a copy of the statement of Certifying Physician for your doctor’s review.
Who is the Prescribing Physician?
Along with certification from the physician managing the patient’s systemic diabetic condition, a podiatrist or other qualified physician, knowledgeable in the fitting of therapeutic shoes and inserts, must prescribe the particular type of footwear necessary.
Who can furnish the Footwear?
Once the patient has both the certifying statement and footwear prescription, the footwear must be fitted to the patient and furnished by a podiatrist, pedorthist, orthotist, prosthetist, or other qualified individual. The prescribing physician may be the supplier. The certifying physician may only be the supplier if the patient is residing in a defined rural area or a defined health professional shortage area.
back to top