Medicare Footwear Benefit for Patients with Diabetes

(continued)

In addition, a valid prescription for shoes and/or inserts – a separate document from the Certifying Physician’s Statement – written by a podiatrist, the same or another MD or DO who provided the Certifying Physician’s Statement, a physician’s assistant, a nurse practitioner, or a clinical nurse specialist and dated prior to the dispensing of shoes/inserts – must also be maintained in the DME supplier’s files.

The Certifying Physician must also document in his/her patient medical record that:

a.) he/she had an in-person visit with the patient during which the patient’s diabetes management was addressed within 6 months prior to delivery of the shoes/inserts; and

b.) the Certifying Physician must sign the Certifying Physician’s Statement on or after the date of the patient’s in-person visit and within 3 months prior to delivery of the shoes/inserts. In addition, the DME supplier must obtain copies of the Certifying Physician’s medical record notes and keep copies of them in the DME supplier’s files.

Prior to selecting the specific items that will be provided, the DME supplier must also conduct and document an in-person evaluation of the patient. Documentation of the in-person evaluation of the patient by the DME supplier at the time of selecting the items that will be provided must include at least the following:

1. an examination of the patient's feet with a description of the abnormalities that will need to be accommodated by the shoes/inserts/modifications;
2. measurements of the patient's feet; and
3. for custom molded shoes and inserts, impressions, casts, or CAD-CAM images of the patient's feet that will be used in creating positive models of the feet.

At the time of delivery, the DME supplier must conduct and document another in-person visit with the patient and document that the provided  shoes/inserts and/or modifications fit properly.

Patients who qualify for custom molded shoes will receive shoes that are:

• constructed over a positive model of the patient’s foot;
• made from leather or other suitable material of equal quality;
• have removable inserts that can be altered or replaced as the patient’s condition warrants; and
• have some form of shoe closure (i.e., they cannot be slip-ons or loafers).

Patients who qualify for depth shoes will receive shoes that:

• have a full length, heel-to-toe filler that, when removed, provides a minimum of 3/16 inch of additional depth used to accommodate custom-molded or customized inserts;
• are made from leather or other suitable material of equal quality;
• have some form of shoe closure; and
• are available in full and half sizes with a minimum of three widths so that the sole is graded to the size and width of the upper portions of the shoes according to the American standard last sizing schedule or its equivalent. (The American standard last sizing schedule is the numerical shoe sizing system used for shoes sold in the United States).

All inserts will be total contact, multiple density, removable inlays that are directly molded to the patient’s foot or a model of that foot and are made of a material suitable for his/her condition.

The process is cumbersome, but will be worth it for qualifying patients who may then avoid foot problems and even a possible amputation down the road.

References:

http://www.medicare.gov/coverage/therapeutic-shoes-or-inserts.html

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

by Robert P. Thompson, C.Ped, Executive Director of IPFH

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