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The Diabetic Shoe Bill
- Short Version
Download
Certificate Statement
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.
PATIENT INFORMATION ON MEDICARE BENEFIT
FOR
THERAPEUTIC FOOTWEAR FOR DIABETICS
n 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.
How Patients
Qualify
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.
What is
Reimbursable
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.
To Start the
Process, Here Is What You Need to Do
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.
Patient
Payment
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.
A Short Note
about the Pedorthic Dispenser/Supplier
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.
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