Medicare therapeutic shoes for diabetics If criteria a, b or c are not met, the therapeutic shoes, inserts and/or modifications to therapeutic shoes will be denied as non-covered. Double Insoles: With the Propét EV (extra volume) insole system, customized fit and comfort is easy. Shoe inserts may be covered and dispensed independent of Therapeutic Shoes". Add a review. D or D. “reasonable and necessary”) and coverage of therapeutic shoes and inserts under the Therapeutic Shoes for Individuals with THERAPEUTIC SHOES FOR PERSONS WITH DIABETES: TIPS FOR CERTIFYING PHYSICIANS AND PODIATRIST SUPPLIERS March 2024 Dear Certifying Physician, Medicare covers therapeutic shoes and inserts for persons with diabetes. A 2019 review published in the Journal of Diabetes and Metabolic Disorders found that therapeutic and orthopedic shoes specifically made for diabetics can help reduce the risk Overview of Medicare’s . In order for your patient to qualify for these shoes Medicare Approved: These styles have been approved for reimbursement under the Medicare Therapeutic Shoes for Persons with Diabetes Benefit (also known as the Therapeutic The Medicare Benefit Policy Manual (CMS Pub. See if you qualify today. As the Certifying Physician, you have a critical Patient eligibility for coverage of Therapeutic Shoes for Persons with Diabetes under Medicare . The burgeoning diabetes epidemic, paired with an aging population, means that more patients will qualify under Medicare’s Therapeutic Shoes for Persons with Diabetes Benefit, also known as the Therapeutic Shoe Bill (TSB), for financial Therapeutic Shoes; No Tie Lace Shoes; Vegan Friendly Shoes; Extra Wide Shoes; Shoes for AFO's & Braces; as well as the exact reimbursement by state. Accessed January 2024. These diabetic shoes are covered if the equirements as specified in this section concerning certification and prescription are 4. If you suffer from diabetes Medicare Part B and Part D may covers some diabetic supplies and could help you with savings. YOU MAY QUALIFY FOR MEDICARE DIABETIC FOOTWEAR COVERAGE. Statement of Certifying Physician for Therapeutic Shoes Patient Name: MBI: I certify that all of the following statements are true: 1. caring for the patient’s diabetic condition. Its origin was based on the high cost of treating diabetic foot wounds, Documentation Checklist – Therapeutic Shoes for Persons with Diabetes; Know the Roles for Provision of Therapeutic Shoes for Persons with Diabetes; Partial Foot, Shoe Insert (Toe Fillers), and Shoe Inserts for Diabetics – Coding Based on Benefit Category – Correct Coding; Therapeutic Shoes for Persons with Diabetes Activity Timeline The tool will help determine if the dates of service, in-person visit, Certification Statement and documentation from another provider when the in-person visit is with a podiatrist, other M. Account For Medicare to pay; two conditions must be documented within the past six months: 1. Diabetic/Therapeutic Shoes (MD or DO Only) Patient Name: _____ DOB: _____ I certify that all of the following statements are true: As the Certifying Physician for diabetic shoes not THERAPEUTIC SHOES FOR PERSONS WITH DIABETES: PHYSICIAN DOCUMENTATION REQUIREMENTS. As required by Medicare, Medicare covers 1 pair of Shoes and 3 pairs of inserts each year! Benefits of Diabetic / Therapeutic Shoes for people living with Diabetes In the United States, as many as 15% of people with diabetes will have lower extremity amputations during their lifetime. A5500 A5512 . This document addresses therapeutic shoes, inserts or modifications to therapeutic shoes for people with diabetes. The therapeutic shoes that are provisioned in the management of the individual's diabetes provides for a pair of diabetic shoes even if only one foot suffers from diabetic foot disease. The statutory coverage criteria for therapeutic shoes including the requirement for an order are specified in the related Policy Article. Therapeutic Shoes for Persons with Diabetes MEDICARE DMERC MEDICAL POLICY Original Policy Effective Date: For services performed on or after 05/01/1993 Therapeutic shoes, inserts and/or modifications to therapeutic shoes are covered if the following criteria are met: 1) The patient has diabetes mellitus (ICD-9 diagnosis codes 250. Smart Feet LLC offers a remarkable opportunity for Veterans and Diabetics with Medicare to obtain therapeutic shoes at absolutely no cost. Section 1: Introduction 5 . 4. (Doctor of Osteopathy) as outlined in the Social Security Act §1861(s) (12). THERAPEUTIC SHOES FOR PERSONS WITH DIABETES: PHYSICIAN DOCUMENTATION REQUIREMENTS Revised November 2024 Dear Physician, Medicare covers therapeutic shoes and inserts for persons with diabetes. o. Therapeutic Shoes Medicare Part B will cover therapeutic shoes or inserts if you have diabetes-related foot conditions like nerve damage or poor circulation. Medicare Part B may cover 80% of the cost for these orthotic devices if they are prescribed by a physician as medically necessary for severe diabetic foot disease. Prosthetics & Orthotics, Prosthetic Devices, & Therapeutic Shoes. 922. Coverage is for one pair of shoes Therapeutic shoes or inserts. Overview of the Therapeutic Shoe Benefit. Note: Please see the following for additional information: CG-DME-10 Durable Medical Equipment; CG-DME-20 Orthopedic Footwear Diabetic Medicare patients are eligible for the Medicare Therapeutic Shoe Bill, allowing access to specialized shoes and orthotics. The shoes are manufactured to be lightweight and prevent loosening (to remain securely on the foot). In order for a beneficiary’s equipment to be eligible for reimbursement the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination must be met. No-Cost Diabetic Shoes Through Medicare: Your Step-by Medicare Form for Diabetic Shoes: How to get diabetic shoes at No Cost* Download Medicare Form for Diabetic Shoes click on icon to download Step 1: Understand Your Eligibility If you're living with diabetes in Philadelphia, you might be eligible to receive therapeutic shoes and inserts. Beneficiaries with Diabetes Therapeutic shoes for diabetics are not DME and are not considered DME or orthotics, but a separate category of coverage under Medicare Part B. Shop now! Phone. How Does the Therapeutic Shoe Program Work. Clinician Checklist for Therapeutic Shoes for Persons with Diabetes Last Updated 12/9/2021 2. May a nurse practitioner (NP) or physician assistant (PA) create the medical record showing treatment for the Collaborative A/B/DME Therapeutic Shoes for Persons with Diabetes Webinar. Deluxe features of diabetic shoes (A5508) will be denied as non-covered. NPs or PAs providing ancillary services as auxiliary personnel could meet the “incident to” requirements in their provision of therapeutic shoes to beneficiaries with diabetes if all of the following criteria are met: 1. 00-250. Accessed Therapeutic Shoes for Persons with Diabetes Questions & Answers (Q&As) Click on a question to expand or Show All / Close All. , physician assistant, nurse practitioner, or clinical nurse specialist that is within 6 months prior to delivery of the shoes/inserts, and that documents one or more of criteria a-f, Insufficient Documentation of Therapeutic Shoes for Persons with Diabetes to be Addressed in National Webinar on November 2, 2022 One (1) pair of custom-molded shoes (including inserts) and two (2) additional pairs of inserts; Qualifying Foot Conditions. or d. The beneficiary has a systemic diabetic condition visit and foot examination conducted in November 2015 and received diabetic shoes in December 2015. Ped) on premises at all times, LICSPS is certified to partake in Medicare's Diabetic Therapeutic Shoe Program. C. or M. In May 1993, Congress amended Medicare statutes to provide partial reimbursement for depth shoes, custom molded shoes, and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes. “reasonable and necessary”) and coverage of therapeutic shoes and inserts under the Therapeutic Shoes for Individuals with Dr. Dear Physician: Therapeutic Shoes for Persons with Diabetes: Physician MPTAC review. Who is prescribing the therapeutic shoes? Name: _____ Credentials: _____ Certificate of Medical Necessity (CMN) for Therapeutic Shoes in Diabetics Following this guidance will help your patients and the Medicare program by verifying that there is medical documentation to support the provisions for therapeutic shoes for persons with diabetes, allowing your patients to receive the items needed to treat their diabetic condition, and allowing Medicare to pay claims appropriately. Laces 1 A5500 Diabetic Extra -Depth Shoes, pair 3 2 1 A5512 Prefabricated Heat Moldable Inserts, pair 3 2 1 A5514 Custom Fabricated Inserts, pair Had the patient received shoes under the Medicare Therapeutic Shoe Program this calendar year? 140 -Therapeutic Shoes for Individuals with Diabetes (Rev. Coverage for extra-depth or custom-molded therapeutic shoes and inserts for individuals with diabetes became a Medicare benefit on 1 May 1993. However, in order to qualify, the Medicare statute mandates specific coverage and documentation requirements that must be met. If you are Diabetic with Medicare as your primary insurance, you are entitled to 1 pair of diabetic footwear each year. To follow a web link, please use the MCD Website. THERAPEUTIC SHOES FOR PERSONS WITH DIABETES: We IMPACT lives. People with Diabetes. The Therapeutic Shoes for Persons with Diabetes program is aimed at preventing complications such as foot ulcers and amputations in diabetic patients. Can the Overview of the Therapeutic Shoe Benefit. Medicare covers such extra-depth shoes for qualifying individuals, as Objective: A three-year demonstration was fielded in three states to evaluate the cost to Medicare of a therapeutic shoes benefit for Medicare Part B beneficiaries with severe diabetic foot disease. They offer pain Medicare covers therapeutic shoes and inserts for persons with diabetes. Since then, Medicare Part B (Medical Insurance) Note: Medicare only covers diabetic shoes and inserts if the doctor is enrolled in Medicare. Title: Diabetic Shoes: Prescribing Practitioner Role (DME MAC Jurisdictions B & C) Author: CGS - CH Subject: DME MAC JB & JC Created Date: 6/21/2023 2:51:47 PM Medicare Therapeutic Shoes For Diabetics (TSD) Program. A podiatrist or other qualified healthcare provider will need to prescribe the shoes and fit them properly. The Therapeutic Shoe Program for Persons with Diabetes was introduced . Item sold as a pair of shoes. The wording “diabetic shoes” in Medically necessary statement #3 was replaced with “therapeutic shoes, inserts or modifications to therapeutic shoes”. LCDs for Orthopedic Footwear (L33641). Discover the best shoes for diabetic feet, designed for comfort and foot health. Medicare allows three pairs of inserts per year. 5300; More. See the medical policy on Therapeutic Shoes for Persons with Diabetes for coverage, documentation, and additional coding guidelines. for coverage by medicare under the therapeutic shoes for diabetics program - this document must be signed by the m. Learn more. 100-02) is being updated to be consistent with the changes made to the DMEPOS Quality Standards. gov. However, there are certain criteria to be aware of: Therapeutic Benefits: Diabetic shoes are not just about aesthetics; they are engineered to provide therapeutic benefits. ) or doctor of osteopathy (D. This patient has diabetes mellitus. – U. You pay 20 percent of the cost once your Part B deductible is met. Current direction on correct coding as well as revised information about the Coding Verification Review project process are included in the article titled: Correct Coding – Inserts Used with Therapeutic Shoes for Persons with Diabetes (A5512, A5513, K0903), published February 1, 2018. d. O . Based on 8 reviews. Standard Documentation Requirements Policy Article - Therapeutic Shoes for Diabetics - Physician Documentation Requirements Posted November 11, 2010 (SPE) Dear Physician, Medicare covers therapeutic shoes and inserts for persons with diabetes. Contractor for the Centers for Medicare & Medicaid Services. Must be ordered by the Member’s treating physician. Sales: 888-357-3226. A prescription for all required diabetic foot items, such as inserts, shoes, or shoe modifications, signed at an in-person appointment within the last 6 months, including your diagnosis and diabetic treatment history. To have orthotics or diabetic shoes covered by Medicare, you must meet the Part B deductible and pay 20 percent of the Medicare-approved amount (this means that Medicare will Therapeutic Shoes for Persons with Diabetes Presented by Noridian Provider Outreach and Education April 2017. DMEPOS Therapeutic Shoes for Persons with Diabetes Templates and Clinical Data Elements (CDEs) Provider Compliance Group Special Open Door Forum June 12, 2018. gov, Medicare will only cover your therapeutic shoes if your doctors and Although therapeutic shoes can be costly, Medicare offers coverage through Medicare Part B (medical insurance) and this significantly lowers the cost to consumers. In accordance with section1833(o)(1) of the Act, payment is limited for each According to MedicareFAQ, Medicare Part B covers therapeutic shoes for diabetics if they are prescribed by a doctor who is enrolled in Medicare. Need therapeutic shoes or inserts? Learn more about your coverage, who's eligible. Medicare Part B (Medical Insurance) covers the furnishing and fitting of either of these each calendar year if you have diabetes and severe diabetic foot disease: One pair of custom-molded shoes and inserts; One pair of extra-depth shoes; Medicare also covers: 2 additional pairs of inserts Medicare Approved: These styles have been approved for reimbursement under the Medicare Therapeutic Shoes for Persons with Diabetes Benefit (also known as the Therapeutic DIABETIC FOOTWEAR PRESCRIPTION FORM Patient: Date of Order: DOB: _ ____ HICN: 1 Pair 3 Pair . Page | 1. DME MAC . Participant Dial- In Number: 1 -(800)-837-1935 The DARCO Gentle Step is a Medicare-approved extra-depth diabetic shoe designed to meet the needs of those with diabetic neuropathy. 0a (6/8/2018) Note: If these CDEs are used: 1) CDEs in black Calibri are required For beneficiaries who are non-diabetic and require accommodation of missing foot digit(s) or forefoot, suppliers must only bill code L5000. Also according to Medicare. In this article, we will cover what exactly is an A5500 diabetic shoes and how you can qualify to be covered by Medicare for these types of shoes. The demonstration produced no definitive evidence that expanding Medicare Part B to cover therapeutic shoes for beneficiaries with severe diabetic foot disease would increase total Medicare costs. Section 2: Medicare coverage for diabetes at-a-glance 7 Roles of various practitioners involved in the decision-making and provision process for diabetic shoes. 7. About us Patients Providers How it works. Our wide selection of therapeutic footwear supports foot health and meets your specific needs. Separate inserts may be covered and dispensed independently of diabetic shoes if the supplier of the shoes verifies in writing that the beneficiary has appropriate footwear into which the insert can be placed. Therapeutic shoes & inserts. Insulin — 30 Anti-diabetic drugs — 31 Diabetes supplies — 31. • It includes the following statements and then requests signature and date from the certifying physician: o "I am the MD supervising "PATIENT NAME'S" comprehensive plan of care for Diabetes Mellitus. The qualification Therapeutic shoes, inserts and/or modifications to therapeutic shoes are reasonable and necessary when meeting the following coverage criteria: 1. O. Subscribe To Newsletters. I understand that the Medicare Therapeutic Shoe Program guidelines are very stringent and that patients do not automatically qualify. 93 Therapeutic Shoes for Persons with Diabetes (L33369) Links in PDF documents are not guaranteed to work. The Medicare fee schedules published by the scope of the Therapeutic Shoes Part B benefit. Medicare Benefit Policy Manual, Chapter 15, §290 – Foot Care. Therapeutic shoes may be custom-molded or depth shoes. Learn more here. Oxford shoes (L3224, L3225) are covered in these situations. 1-866-923-2423. If not enrolled, Medicare won’t pay the claims submitted by them. Therapeutic Shoes/Inserts for Diabetics Pre-Pay Review Quarterly Status Report Below is the analysis of claim denials for therapeutic shoes and inserts for diabetic persons HCPCS codes A5500, A5512, and A5513 reviewed July 1 – September 30, 2024. As the Certifying Physician, you have a critical role in the process, with statutory obligations that include the following actions: 1. managing the patient’s systemic diabetic condition and the statements below must be documented in the patient's medical record - which we must also receive a copy of to verify the items below. In addition, the definition of inserts located in Chapter 15, §140, Therapeutic Shoes for Individuals with Diabetes in the Medicare Benefit Policy Manual (Pub. Therapeutic shoes or inserts — 26 Replacing lost or damaged durable medical equipment or supplies in a disaster or emergency — 28. 5 star: 75. Diabetic Depth Shoes, pair Prefabricated inserts pairs-multiple density, direct formed, molded to foot with external heat source (i. What is an A5500 Diabetic Shoe? An A5500 shoe is an off-the-shelf shoe manufactured to . When the patient has diabetes mellitus (see ICD-9 CM diagnosis codes below); and Therapeutic shoes for diabetics may consist of molded shoes or depth shoes and/or inserts and are specially Title: Diabetic Shoes: Prescribing Practitioner Role (DME MAC Jurisdictions B & C) Author: CGS - CH Subject: DME MAC JB & JC Created Date: 6/21/2023 2:51:47 PM Therapeutic Shoes/Inserts for Diabetics Pre-Pay Review Quarterly Status Report Below is the analysis of claim denials for therapeutic shoes/inserts for diabetic persons HCPCS codes A5500, A5512, and A5513 reviewed July 1 – September 30, 2024. 2. Humana or your insurance may cover the cost. e. 2:00-3:00 pm EasternTime Provider Compliance Group Center for Program Integrity. 100-02), Chapter 15, Section 140 allows for a pair of shoes for a person with diabetes. Medicare Benefit Policy Manual, Chapter 15- Covered Medical and Other Health Services, §140, Therapeutic Shoes for Individuals with Diabetes 17. Revised May 2023 . 16- General Exclusions from Coverage, §180- Services Related to and Required as a Result of Services Which Are Not Covered Under 18. Patient eligibility for coverage of Therapeutic Shoes for Persons with Diabetes under Medicare . Certifying Physician: The practitioner actively treating and managing the patient's systemic diabetic condition. Therapeutic Shoes for Individuals with Diabetes (MBPM, Chapter 15, Section 140) • As of May 1, 1993, coverage of depth or custom-molded therapeutic shoes and inserts for individuals with diabetes is available. D. Doctors and suppliers must meet guidelines to enroll and stay enrolled The following is a list of resources to help you navigate Medicare as it relates to Diabetic and Therapeutic footwear: Web Links:Medicare Reimbursement Rates for 2025 (DMEPOS Fee Schedule Info)Therapeutic Shoes - Noridian (noridianmedicare. Therapeutic Sport; Comfort Socks. As the prevalence of diabetes (and obesity) began to rise sharply in the 1980s, a group of healthcare providers, including leading endocrinologists, orthopedists, and pedorthists, came together with Congress to develop a plan that would Medicare Coverage for Therapeutic Shoes and Inserts. 7kdqn \rx iru fkrrvlqj +dqjhu &olqlf :h orrn iruzdug wr fdulqj iru \rx <rxu lqvxudqfh surylghu uhtxluhv wkdw zh froohfw vshflilf grfxphqwdwlrq iurp \rx dqg As a fully accredited facility with a Certified Pedorthist (C. Medicare Benefit Policy Manual, Ch. (Circle all that apply): Statement of Certifying Physician for Therapeutic Shoes. Each year, you may have coverage for: A pair of Inserts used with therapeutic shoes for persons with diabetes coded as A5512, A5513, and K0903 must meet certain specifications outlined in the Therapeutic Shoes for Persons with Diabetes Local Coverage Determination (LCD) and related Policy Article, as well as the requirements for custom fabrication set out in the Durable Medical Equipment, Prosthetics, Washington, D. Therapeutic Shoes for Persons with Diabetes on the NAS web site at . 3 Pair . the only item that Medicare pays for to prevent bad things from happening to your feet if you are a diabetic and meet Medicare's requirements. If you have prescription for Diabetic Footwear and you are looking to be fitted under Medicare's Therapeutic Shoes For Diabetics Program we welecome you to try our FREE resorce for finding foot care professionals in your area that may accept Medicare Assignment. but a separate category of coverage under Medicare Part B. Because Medicare covers shoes and Medicare covers therapeutic shoes and inserts for persons with diabetes. The 1993 Therapeutic Shoe Bill extends Medicare coverage to diabetic patients that qualify. This statutory benefit is limited to one pair of shoes and up to 3 pairs of inserts or shoe modifications per calendar year. The Benefit Policy manual language is revised to read as follows: Therapeutic Shoes for Individuals with Diabetes (Medicare/Commercial/NH Medicaid) 3. . Contractor Information Medicare Benefit Policy Manual (IOM 100-02), Chapter 15, Section 140 Coverage Guidance Following this guidance will help your patients and the Medicare program by verifying that there is medical documentation to support the provisions for therapeutic shoes for persons with diabetes, allowing your patients to receive the items needed to treat their diabetic condition, and allowing Medicare to pay claims appropriately. To qualify for this benefit, healthcare practitioners must adhere to strict guidelines, which may include both in-person and telehealth visits. Therapeutic Shoes and inserts are covered under the Therapeutic Shoes for Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). Section 4: Medicare coverage for diabetes drugs — 29. In order for a beneficiary’s equipment to be Use this page to view details for the Local Coverage Determination for Therapeutic Shoes for Persons with Diabetes. Extra-depth shoes with inserts or custom molded shoes with inserts for an individual with diabetes is a separate Medicare Part B benefit category in accordance with section 1861(s)(12) of the Act. S. revised June 2007. Remove the bottom insole to provide a little extra volume or remove both to In May 1993, congress passed the Therapeutic Shoe Bill (TSB). Each shoe is equally The tool will help determine if the dates of service, in-person visit, Certification Statement and documentation from another provider when the in-person visit is with a podiatrist, other M. Therapeutic Shoes/Inserts for Diabetics Pre-Pay Review Quarterly Status Report Below is the analysis of claim denials for therapeutic shoes/inserts for diabetic persons HCPCS codes A5500, A5512, and A5513 reviewed July 1 – September 30, 2024. Shoe and insert coverage is limited to one of the following within a calendar year: One pair of custom molded shoes (including inserts that come with the shoes) and two pairs of multidensity inserts, or One pair of extra-depth shoes; Medicare also covers: 2 additional pairs of inserts each calendar year for custom-molded shoes; 3 pairs of inserts each calendar year for extra-depth shoes; Medicare will cover shoe modifications instead of inserts. A Statement of Certifying Physician completed by the MD/DO treating your diabetic condition, signed within the last 3 months. The Centers for Medicare & Medicaid Services (CMS) has recently provided guidance to the DME MACs about the delegation of certifying physician (MD or DO) comprehensive management of diabetes responsibilities to nurse practitioners (NP) and physician assistants (PA) prescribing therapeutic shoes and inserts for persons with diabetes. You may access the Therapeutic Shoes for Persons with Diabetes (TSPD) LCD and Related Policy Article on the CMS website under the Medicare Coverage Database. I agree with the above findings and that he patient needs therapeutic shoes and inserts. , physician assistant, nurse practitioner, or clinical nurse specialist that is within 6 months prior to delivery of the shoes/inserts, and that documents one or more of criteria a-f, statement of certifying physician diabetic therapeutic footwear (This form must be signed by the D. Diabetic shoes and inserts are designed to create extra depth in the shoe so that the shoe is not putting extra pressure on your feet or toes. Find comfortable, Medicare-approved diabetic shoes. Following this guidance will help your patients and the Medicare program by verifying there is medical documentation to support the provisions for Therapeutic Shoes for Persons with Diabetes, allow your patients to receive the items needed to treat their diabetic condition, and allow Medicare to pay claims appropriately. Shoes are also covered if they are an integral part of a covered leg brace described by codes L1900, L1920, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2050, L2060, L2080, or L2090. The Patient has to be under a comprehensive plan of care for Diabetes. Use of the Suggested Clinical Data Elements is voluntary / optional . MPTAC review. home; Diabetic Socks and our therapeutic shoes are also accurately sized and padded to ensure that there is enough room in the toe-box, heel, and arch of the shoe. Coverage of therapeutic shoes for persons with diabetes is based on Social Security Act §1862(a)(1)(A) provisions (i. 03/08/2007. • This type of diabetic shoes is covered if the requirements specified in the “Medicare Benefits This patient has diabetes mellitus. However, in order for these Title: Diabetic Shoes: Certifying Physician Role (DME MAC Jurisdictions B & C) Author: CGS - CH Subject: DME MAC JB & JC Created Date: 6/21/2023 2:54:07 PM Therapeutic Shoes (for Diabetes) TRICARE covers inserts and custom molded or extra-depth shoes for people with diabetes. This article is retired effective February 1, 2018. Therapeutic Shoes Progress Note Template Suggested CDEs Draft R1. You must still meet all the eligibility requirements for Medicare Advantage plans, including having a doctor who is part of the plan’s network. This practitioner must be an M. This patient has one or more of the following conditions. ) Yes, Medicare provides coverage for therapeutic shoes and inserts for individuals with diabetes, under the Therapeutic Shoes for Individuals with Diabetes benefit. Description, Discussion and References updated. See more Therapeutic Shoes and inserts are covered under the Therapeutic Shoes for Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). Medicare Benefit Policy Manual, Chapter 15, §140 - Therapeutic Shoes for Individuals with •NPs and PAs as certifying physicians for therapeutic shoes and inserts: CMS has provided guidance to the durable medical equipment (DME) MACs about the delegation of certifying physician (MD or DO) comprehensive management of diabetes responsibilities to NPs and PAs prescribing therapeutic shoes and inserts for persons with diabetes. Items represented by code A5510 reflect compression molding to Therapeutic Shoes and inserts are covered under the Therapeutic Shoes for Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). Medicare Advantage plans are a type of health insurance that helps cover the costs of diabetic shoes including molded shoes and extra-depth shoes. Roles of various practitioners involved in the decision-making and provision process for diabetic shoes. “reasonable and necessary”) and coverage of therapeutic shoes and inserts under the Therapeutic Shoes for Individuals with Local Coverage Determination Therapeutic Shoes for Persons with Diabetes \(L33369\) and Policy Article \(A52501\) Standard Documentation Requirements Policy Article - A55426. (Circle all that apply): a) History of The Medicare Benefit Policy Manual (CMS Pub. Senators Susan Collins (R-ME) and Sherrod Brown (D-OH) reintroduced their bipartisan Promoting Access to Diabetic Shoes Act that would improve diabetic patients’ access to therapeutic shoes by allowing nurse practitioners (NPs) and physician associates/physician assistants (PAs) - who often act as sole primary care providers for many For BlueCHiP for Medicare members, therapeutic shoes, inserts and/or modifications to therapeutic shoes are typically covered for the following: 1. Therapeutic Shoe Program for . OR A5513 . Therapeutic Shoes for Persons with Diabetes Progress Note . Dear Physician, Medicare covers therapeutic shoes and inserts for persons with diabetes. Medicare. If you need therapeutic shoes or inserts, Medicare will cover 80% of the approved amount after you meet your yearly Part B deductible. How do I get an insulin pump? How do I get therapeutic shoes? How much training is covered? What will I learn in this training? Need a copy of this booklet in Spanish? Therapeutic shoes or inserts Go to page 11 Part B covers therapeutic shoes or inserts if you have diabetes and severe diabetic foot disease 20% of the Medicare-approved amount after the yearly Part B deductible “Welcome to Medicare” preventive Go to page 20 Within the first 12 months you have Part B, Medicare covers a one-time The statutory coverage criteria for therapeutic shoes including the requirement for an order are specified in the related Policy Article. Learn what to look for when choosing diabetic footwear. 75%: 4 The doctor who treats your diabetes must certify you need therapeutic shoes or inserts and that they are Does Medigap cover the cost of diabetic shoes? Medicare Supplement Insurance, or Medigap, helps to fill the “gaps” in Original Medicare by covering costs like deductibles, co-pays, and co-insurance. Documentation Checklist – Therapeutic Shoes for Persons with Diabetes; Know the Roles for Provision of Therapeutic Shoes for Persons with Diabetes; Partial Foot, Shoe Insert (Toe Fillers), and Shoe Inserts for The Centers for Medicare & Medicaid Services (CMS) has recently provided guidance to the DME MACs about the delegation of certifying physician (MD or DO) comprehensive management of diabetes responsibilities to nurse practitioners (NP) and physician assistants (PA) prescribing therapeutic shoes and inserts for persons with diabetes. Medicare’s Stance on Therapeutic Shoes and Inserts: Medicare Part B covers therapeutic shoes and inserts for individuals with specific foot conditions. Since 1993, Medicare has covered certain therapeutic shoes, inserts and modifications for persons with diabetes who meet specified qualifying requirements. Codes must be billed with a Medicare Coverage of Diabetes Supplies MLN Fact Sheet Medicare covers diabetes supplies under Medicare Part B and Medicare drug plans (Part D). heat gun). ) co-signs the medical record? See the medical policy on Therapeutic Shoes for Persons with Diabetes for details. Get helpful information, understand your options at Medicare. A standard written order (SWO). Suggested Clinical Data Elements (CDEs) Version R1. Therapeutic shoes, inserts and/or modifications to therapeutic shoes are covered if the following criteria are met: a. A pair of therapeutic shoes suited for diabetic patients and three pairs of foot insert every twelve months. Comfort Annie X Diabetic shoes are the “ultimate in comfortable, accommodative diabetics shoes,” says podiatrist Elizabeth Daughtry, DPM, based in Newton Grove, Medicare covers therapeutic shoes and inserts for persons with diabetes as established by the Social Security Act Section 1861(s) (12). Title: Chapter 9_TSD. Within 5 years of the benefit’s availability, a report from the Office of the Inspector General of the United States found that 57% of paid claims for therapeutic shoes had missing or inadequate Best Shoes For People With Diabetes Of 2025, According To Podiatrists. Is the certifying physician (managing the patient’s diabetes and specifying condition indicated in 1) an MD or DO? Y N 5. Research design and methods: Eligible Medicare beneficiaries who applied were randomly assigned to either a treatment group that received the extra therapeutic shoe coverage or a Therapeutic Shoes for Persons with Diabetes Questions & Answers (Q&As) Click on a question to expand or Show All / Close All. Q6. Diabetic shoes are covered if the requirements as specified in this section concerning certification and prescription at Therapeutic Specialties, Inc. Codes A5512 and A5513 describe inserts used with therapeutic shoes provided to persons with diabetes (see below) and must not be billed for non-diabetic beneficiaries. The beneficiary must be treated under a comprehensive diabetes care plan and need therapeutic shoes or inserts THERAPEUTIC SHOES FOR PERSONS WITH DIABETES: PHYSICIAN DOCUMENTATION REQUIREMENTS Revised December 2021 The following documentation is required in order for Medicare to pay for therapeutic shoes and inserts and must be provided by the physician to the supplier, if requested: 1. Our dedicated team is committed to providing high-quality footwear that prioritizes comfort and The statutory coverage criteria for therapeutic shoes including the requirement for an order are specified in the related Policy Article. 0a 6/8/2018. May a nurse practitioner (NP) or physician assistant (PA) create the medical record showing treatment for the diabetic condition and is it then sufficient if the medical doctor (M. Note: Please see the following for additional information: CG-DME-10 Durable Medical Equipment; CG-DME-20 Orthopedic Footwear Therapeutic Shoes (for Diabetes) TRICARE covers inserts and custom molded or extra-depth shoes for people with diabetes. Part B covers these if the patient has diabetes: Blood glucose self-testing equipment and supplies Durable insulin pumps and the insulin used in those pumps Therapeutic shoes and inserts For Therapeutic Shoes & Inserts for Persons with Diabetes to be covered by Medicare, the patient’s medical record must contain su˜cient documentation about the patient’s medical condition to substantiate the quali˚cations and medical necessity for the type and quantity Therapeutic Shoes/Inserts for Diabetics Pre-Pay Review Quarterly Status Report Below is the analysis of claim denials for therapeutic shoes and inserts for diabetic persons HCPCS codes A5500, A5512, and A5513 reviewed July 1 – September 30, 2024. This can Medicare Approved: These styles have been approved for reimbursement under the Medicare Therapeutic Shoes for Persons with Diabetes Benefit (also known as the Therapeutic 16. The Stability Walker A5500 Women’s Diabetic Pewter Suede has been coded for reimbursement under the Medicare Therapeutic Shoes for Persons with Diabetes Benefit which makes it a great shoe to pick up for women with diabetes. Please provide us with your information below. Must be ordered by the Member ¶s treating physician. p65 Author: RHSTRO Created Date: 11/19/2002 4:36:34 PM Therapeutic shoes or inserts Go to page 11 Part B covers therapeutic shoes or inserts if you have diabetes and severe diabetic foot disease 20% of the Medicare-approved amount after the yearly Part B deductible “Welcome to Medicare” preventive Go to page 20 Within the first 12 months you have Part B, Medicare covers a one-time Medicare Approved Diabetic shoes and sneakers at no or little cost to you. in 1993 and represented one of Medi-care’s first initiatives to provide cov-erage as a preventative approach to care. DME MAC Joint Publication The 2024 Medicare reimbursement rates for diabetic shoes and inserts have been released! We've provided the A5500, A5512 and A5514 rates, and state rates. (Doctor of Medicine) or D. Disclaimer – Fee for service or Medicare HMO – Permanent address on file with Social Security • Same or Same (IVR or Noridian Medicare Portal) • Coverage criteria Current Medicare Coverage: a) Therapeutic shoes not attached to braces for patients with diabetes mellitus b) Shoe inserts with or without therapeutic shoes for patients with diabetes. Reviewed. Depth-inlay or custom molded shoes for diabetics (A5500-A5501) and related inserts and modifications (A5503-A5511) are billed using these A-codes whether or not the shoe is an integral part of a brace. References & General Information updated. 1-800-893-8085. If you have any questions or concerns regarding diabetic shoes Diabetic Footwear. To facilitate implementation of this new category of therapeutic shoe inserts, the following new code will be added to the HCPCS code set effective April 1, 2018: K0903: For diabetics only, multiple density insert, made by direct carving with CAM This document addresses therapeutic shoes, inserts or modifications to therapeutic shoes for people with diabetes. TIPS FOR CERTIFYING PHYSICIANS AND PODIATRIST SUPPLIERS March 2024 Dear Certifying Physician, Medicare covers therapeutic shoes and inserts for persons with diabetes. 8. Conforms to the Medicare Therapeutic Shoe Bill. However, our findings indicate that the demonstration was successful at increasing therapeutic shoe ownership and was instrumental in increasing Therapeutic Shoes and inserts are covered under the Therapeutic Shoes for Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). Shoe and insert coverage is limited to one of the following within a calendar year: One pair of custom molded shoes (including inserts that come with the shoes) and two pairs of multidensity inserts, or Title: Diabetic Shoes: Supplier Role (DME MAC Jurisdictions B & C) Author: CGS - CH Subject: DME MAC JB & JC Created Date: 6/21/2023 2:50:24 PM Therapeutic shoes, inserts and/or modifications to therapeutic shoes are reasonable and necessary when meeting the following coverage criteria: 1. 1, 10-01-03) B3-2134 Coverage of therapeutic shoes (depth or custom-molded) along with inserts for individuals with diabetes is available as of May 1, 1993. Therapeutic shoes are designed to accommodate custom-fitted diabetic insoles, as well as encourage a normal gait. 8 reviews for GentleStep™ Extra-Depth Diabetic Shoes. To qualify for coverage, you must have diabetes and one or more of the following conditions: In addition to diabetic shoes, Medicare covers a range of supplies and services for managing diabetes Medicare Part B covers therapeutic shoes and inserts, or orthotics, for people with diabetes and severe diabetes-related foot disease. The therapeutic shoes that are provisioned in the management of the individual's Studies have shown that 25 percent of persons with diabetes develop foot problems related to the disease and that up to 15 percent of persons with diabetes develop foot ulcers. note. To find the right Medicare plan for you, we can help by providing you with all From the Therapeutic Shoes for Persons with Diabetes Policy Article [A52501): The Supplier is the person or entity that actually furnishes the shoe, modification, and/or insert to the beneficiary and bills Medicare. com)This is a link to the main Medicare page about Therapeutic Shoes and InsertsTherapeutic Shoes for Persons with bill the Medicare program once the beneficiary takes possession of the shoes as long as it is after November 5 (the physician’s signature date on the order). Providers – Do you need assistance in understanding what is needed when ordering diabetic shoes? This Collaborative webinar on Therapeutic Shoes for Persons with Diabetes is your opportunity to hear directly from the Medicare Administrative Contractors (MACs): As a Medicare Patient you may qualify for one pair of diabetic shoes per calendar year through the Therapeutic Shoes for Diabetics Program. Medicare Approved: These styles have been approved for reimbursement under the Medicare Therapeutic Shoes for Persons with Diabetes Benefit (also known as the Therapeutic Shoe Bill). Ankle; Crew; Merry-Jane; No-Show; Over-the-Calf; Extra Roomy; Transmet; Medicare; Contact Us; Find a Provider; For Providers; Talk to an Expert 866. Centers fort Medicare and Medicaid Services. Part B Coverage. For Medicare to cover your therapeutic shoes or inserts, your doctors and suppliers need to be enrolled in Medicare and meet certain standards. whtu vmoa iwmpv vyc vpvyld krch lzwjn bsk ytblmr thwes