TOOLKIT DIRECTORY
Medicare coverage of Therapeutic Footwear
Therapeutic Diabetic shoes, inserts and/or modifications to these shoes are covered only when all of the following
criteria are met:
- The patient has diabetes mellitus (ICD-9 diagnosis codes 250.00-250.93); and
- The patient has one or more of the following conditions:
(a)Previous amputation of the foot, or part of either foot, or
(b)History of previous foot ulceration of either foot, or
(c)History of pre-ulcerative calluses of either foot, or
(d) Peripheral neuropathy with evidence of callus formation of either foot, or
(e) Foot deformity of either foot, or
(f)Poor circulation in either foot; and
- The certifying physician who is managing the patient's systemic diabetes condition has certified that
indications (1) and (2) are met and that he/she is treating the patient under a comprehensive plan of care for
his/her diabetes and that the patient needs diabetic shoes.
The PRESCRIBING Physician must actually write the order for the therapeutic shoes, modifications and inserts. The
prescribing MD may be a podiatrist, M.D. or D.O.
The CERTIFYING Physician provides the medical care for the patient’s diabetic condition. The certifying physician
must be an M.D. or D.O. and may not be a podiatrist. The certifying physician may not be the supplier unless the
patient resides in a defined rural area or a defined health professional shortage area.
The SUPPLIER furnishes the prescribed shoes, inserts and modifications and bills Medicare on the patient’s behalf.
The supplier may be an orthotist, prosthetist, pedorthist, podiatrist or other qualified professional. The supplier is
responsible to retain all documentation in the supplier’s patient file.
Medicare specifically defines covered shoes, inserts and modifications. In order to qualify for inserts and/or
modifications only, the inserts/modifications MUST be used in qualifying footwear. The supplier must certify that the
footwear to be used meets these requirements. The inserts/ modifications supplied for use in non-covered footwear
are NOT a Medicare covered item.
Nobbe Orthopedics is unable to certify footwear obtained from any other supplier for use of diabetic inserts and/or
modifications.
Nobbe Orthopedics has provided you with a detailed prescription for completion (diagnosis, signed and
dated) by your PRESCRIBING physician. We have also provided a statement of certifying physician for
therapeutic shoes for completion (condition circled in item 2a-2f, signed and dated) by your CERTIFYING
physician. Both items must be completed by your physician(s) and the originals returned to Nobbe
Orthopedics prior to obtaining therapeutic diabetic footwear. We are unable to accept faxed or duplicate
copies. It is the patient’s responsibility to provide this documentation prior to ordering or obtaining
therapeutic footwear.
Claims cannot be submitted without this documentation.
Please contact our office directly should you have any questions.
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