Medicare's Therapuetic Shoe Bill

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What is the Medicare Therapeutic Shoe Bill? 

In 1993 with the passing of Medicare's Therapeutic Shoe Bill, Medicare (Part B) extended coverage to diabetic patients for Orthotic/Therapeutic footwear and orthotic inserts. This protective footwear can help in the fight to prevent the 90,000 diabetic amputations that occur each year. Of the 90,000 amputations that do occur each year 25% are due to improper footwear

Medicare covers diabetic patients for one pair of extra-depth shoes and three pair of multi-density inserts per year.

What is covered?

Coverage Limitations:
Coverage is limited to one of the following within 1 calendar year:

1 pair of Custom shoes and 2 additional pairs of custom multi-density inserts.
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.

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:

a. History of partial or complete amputation of the foot.
b. History of previous foot ulceration.
c. History of pre-ulcerative callus formation.
d. Peripheral neuropathy with evidence of callus formation.
e. Foot deformity
f. Poor circulation

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.

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.

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.

Southeast Orthotics, Inc. is an Approved Medicare Provider.