Diabetic Shoe Bill Short

NOTE: If this is not enough info for you, then go to the Detailed Version. If you feel you qualify, then contact us for a free fitting. If you live outside of our network (Texas) then here is a list of pedorthists that my be able to help you in your area.

According to the American Diabetes Association, there are approximately 16 million Americans with diabetes. Unfortunately, this number continues to grow. Twenty-five percent of persons with diabetes develop foot problems related to the disease. Recognizing this problem, Congress approved the Medicare Therapeutic Shoe Bill, helping thousands of persons with diabetes obtain protective footwear and inserts.

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. The Centers for Disease Control has estimated that 86,000 lower limb amputations due to diabetes occur annually – and experts agree that most are preventable with appropriate footwear that is properly fit.

The physician (M.D. or D.O.) who manages the patient's systemic diabetic condition is called the certifying physician. The certifying physician must state (see form on other side) that the patient has diabetes mellitus, has one or more of the conditions which Medicare describes as placing the patient at risk, is being treated under a comprehensive plan of care for his/her diabetes and needs therapeutic shoes and/or inserts because of the diabetes.

Within a given calendar year, the qualifying patient can receive 80% of the allowed amounts for one pair of depth shoes and three pairs of inserts OR one pair of custom molded shoes (including inserts) and two additional pairs of inserts. Also: 1) shoe modifications can be substituted for an insert; and 2) custom molded shoes are only covered when the patient has a foot deformity that cannot be accommodated by a depth shoe.

For a qualified patient to receive this benefit, the certifying physician (M.D. or D.O.) must review and sign a "Statement of Certifying Physician for Therapeutic Shoes" and the prescribing physician (D.P.M., M.D. or D.O.) must complete an appropriate prescription prior to the dispensing of the devices. The patient can see a qualified pedorthist, orthotist, prosthetist, or podiatrist to have the prescription filled. The supplier will then keep the documentation on file and submit the claim to Medicare for traditional fee-for-service Medicare patients. PLEASE NOTE: Suppliers may not be able to dispense or submit claims for these devices to Medicare patients enrolled in Medicare + Choice (HMO-type) healthcare plans.

The Centers for Medicare & Medicaid Services ([CMS], formerly known as Health Care Financing Administration [HCFA]) will reimburse 80% of the amount it designates as “allowable,” with the patient responsible for paying the dispenser/supplier a minimum of 20% of the total payment amount. If the Medicare supplier does not accept assignment of the claim, the patient is responsible for the entire amount and will receive reimbursement directly from Medicare for 80% of the allowable amount. PLEASE NOTE: Some Medicare suppliers may not accept assignment if the allowable amount is too low to cover the appropriate materials and services. In these situations, the total cost to the patient may be higher than the allowable amount. If so, the patient is usually expected to pay the Medicare supplier in full before he or she receives reimbursement from Medicare.

Many manufacturers make shoes in varying styles and colors that can be termed therapeutic. However, therapeutic footwear is by nature medical, and fitting it to the patient’s foot requires special skills and care. The pedorthic profession involves the design, fit, and modification of shoes and related foot devices to alleviate foot problems caused by disease, overuse or injury. A certified pedorthist (C.Ped.) is a person who has met initial and continuing educational requirements, passed a comprehensive written exam and adheres to the standards of pedorthic practice established by The Board for Certification in Pedorthics (BCP). To find a C.Ped. in your area, click here or send a stamped, self-addressed envelope to: Board for Certification in Pedorthics, 2517 Eastlake Avenue East., Suite 200, Seattle, WA 98102.