Medicare Shoe Bill
As a Diabetic patient you should be cautious when procuring therapeutic shoes and inserts under the Medicare Therapeutic Shoe Bill to insure you are receiving the level of service intended. The evaluation, measuring, casting, and fitting of these devices in a clinical setting is a process that involves considerable personal contact between the practitioner and the patient. This is as it should be. Care is taken by the provider of these devices to insure proper fit and function. Patient education and follow up is done in the office. Adjustments are often needed after initial fitting. The potential complications which can follow improper fitting of these devices can be serious. Modifications and adjustments to the shoes and inserts are sometimes needed. These can only be done by someone with the proper training and equipment.
Be aware of high volume, minimal patient contact operations. They may send someone to measure and cast you - they may not. Often the shoes are mailed to you to try on yourself and you are expected to call them if there are any "problems." These businesses are receiving the same reimbursement from medicare for your care that the certified and licensed professional receives for spending time with you in his or her clinical office. But, you the patient are clearly not receiving the level of care intended by the Medicare therapeutic Shoe bill.
MEDICARE'S THERAPEUTIC SHOE BILL
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:
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 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 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.