Diabetic Shoes

Special shoes to meet the needs of people with diabetes

South Carolina residents call us to set up your shoe fitting appointment today.....

MEDICARE THERAPEUTIC SHOE BILL NEW MEDICARE COVERAGE:

THERAPEUTIC SHOES FOR DIABETIC PATIENTS

Providers of footwear and foot care have a unique and unparalleled opportunity to help qualified diabetic patients. In an unprecedented move, Congress amended the Medicare statutes to provide partial reimbursement for depth shoes, custom molded shoes, and shoe inserts to qualifying Medicare Part B diabetic patients

Designed to prevent lower limb amputations prevalent in long-term diabetic patients, this new Medicare benefit has the potential to prevent patient suffering, prolong patient life, and save money. According to the CDC, in 1990 there were over 54,000 lower limb amputations due to diabetes. Experts agree that most of these amputations are preventable with appropriate footwear and orthoses

How Patients Qualify:

The physician (M.D. or D.O.) who is managing the patient's systemic diabetic condition must certify that:

1. The patient has diabetes mellitus (lCD-9 diagnosis codes 250.00 - 250.91)

2. The patient has 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

3. The physician who is managing the patient's systemic diabetes condition has certified that indications 1 & 2 are met and that he/she is treating the patient under a comprehensive plan of care for his/her diabetes and that the patient needs therapeutic shoes

What is Reimbursable:

A qualifying patient is limited to one of the following footwear categories within one calendar year, reimbursed at 80% of the allowable amount:

• One pair of depth shoes and three pair of inserts

• One pair of custom molded shoes (including inserts) and two additional pairs of inserts.

Additionally:

1. Separate inserts may be covered under certain criteria

2. A shoe modification will be covered as a substitute for an insert

3. A custom molded shoe is covered when the patient has a foot deformity, which cannot be accommodated by a depth shoe

To Start the Process:

For a qualified patient to receive this important preventive care,

1. The Certifying Physician (managing the patient's systemic diabetes) must review and sign a Statement of Certifying Physician for Therapeutic Shoes (National Direct will handle this for you)

2. The Prescribing Physician must complete a footwear prescription (see sample form)

Once the patient has the certifying statement and the footwear prescription, he/she can measured for a custom fit pair of shoes.

National Direct will then submit the Medicare claim (Form HCFA 1500) to the appropriate Durable Medical Equipment Regional Carrier (DMERC), keeping copies of the claim form and the original prescription and statement

That's all there is to it! You will be on your way to new , great fitting shoes!!!