Medicare policy for therapeutic shoes and inserts
Effective 1/1/2011
An M.D. or D.O. must be managing the patient's diabetes under a comprehensive plan of care and must certify that the patient needs therapeutic shoes and the certifying physician must document that the patient has one or more of the following qualifying conditions:
- Foot deformity
- Current or previous foot ulceration
- Current or previous pre-ulcerative calluses
- Previous partial amputation of one or both feet or complete amputation of one foot
- Peripheral neuropathy with evidence of callus formation
- Poor circulation
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. A detailed written order. This can be prepared by the supplier but must be signed and dated by you to indicate agreement.
2. A copy of an office visit note from your medical records that shows that you are managing the patients diabetes. This note should be within 6 months prior to delivery of the shoes and inserts.
3. Either(a)a copy of an office visit note from your medical record that describes one of the qualifying conditions or (b) an office visit note from another physicians (podiatrist) or form a PA, NP, or CNS that describes one of the qualifying conditions. If option (b) is used, you must sign, date, and make a note on that document indicating your agreement and send that to the supplier. The note documenting the qualifying condition(s) must be more detailed that the general descriptions that are listed above.
4. A certification form stating that the coverage criteria described above have been met. This form will be provided by the supplier but must be completed, signed, and dated by you after the visits described in #2 and 3. If option 3(b) is used, that visit note must be signed prior to or at the same time as the completion of the certification form.
An M.D. or D.O. must be managing the patient's diabetes under a comprehensive plan of care and must certify that the patient needs therapeutic shoes and the certifying physician must document that the patient has one or more of the following qualifying conditions:
- Foot deformity
- Current or previous foot ulceration
- Current or previous pre-ulcerative calluses
- Previous partial amputation of one or both feet or complete amputation of one foot
- Peripheral neuropathy with evidence of callus formation
- Poor circulation
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. A detailed written order. This can be prepared by the supplier but must be signed and dated by you to indicate agreement.
2. A copy of an office visit note from your medical records that shows that you are managing the patients diabetes. This note should be within 6 months prior to delivery of the shoes and inserts.
3. Either(a)a copy of an office visit note from your medical record that describes one of the qualifying conditions or (b) an office visit note from another physicians (podiatrist) or form a PA, NP, or CNS that describes one of the qualifying conditions. If option (b) is used, you must sign, date, and make a note on that document indicating your agreement and send that to the supplier. The note documenting the qualifying condition(s) must be more detailed that the general descriptions that are listed above.
4. A certification form stating that the coverage criteria described above have been met. This form will be provided by the supplier but must be completed, signed, and dated by you after the visits described in #2 and 3. If option 3(b) is used, that visit note must be signed prior to or at the same time as the completion of the certification form.
posted by The OPBS Team
@
11:48 AM
