Medicare Therapeutic Shoe Bill Information

The Medicare Therapeutic Shoe Bill has extended Medicare (Part B) coverage to special footwear for Diabetic patients. This includes extra-depth shoes and many of our multi-density custom and semi-custom foot orthotics. The passing of this bill will help prevent the 54,000 diabetic amputations that take place each year.

Who is covered?

To be covered you must meet the following conditions:

1. You are covered under Medicare Part B

2. You have Diabetes

3. You have one or more of the following conditions:

  • Loss of one foot or part of a foot
  • Amputation of toe or partial toe of either foot
  • History of sores on your feet
  • History of pre-ulcerative calluses of either foot
  • Nerve damage in your feet and calluses on either foot
  • Deformity of either foot (for example, hammertoe or bunions)
  • Poor circulation in either foot.

4. Your doctor has certified your need in writing that states:
  • You meet the criteria for the shoes
  • The doctor is treating you under a comprehensive plan of care for diabetes
  • The exact reasons you need the therapeutic shoes (any customization, inserts, etc.)

Only an M.D. or a D.O. can sign the certification statement (explained below); a podiatrist may not, even though a podiatrist can write the prescription. You will also need a new order and certification statement for the replacement of any shoe, as well as for any inserts or modifications each year when they are purchased. When the certification statement and prescription are complete, both of these must be kept on file by the supplier.

What is covered?

Per calendar year, one of the following is covered:

  • One pair of off-the-shelf extra-depth shoes and three additional pairs of heat-molded custom inserts

    OR

  • One pair of off-the-shelf extra-depth shoes and three additional pairs of custom-molded inserts taken from a cast impression of your feet.

    OR

  • One pair of custom-molded shoes, including the inserts provided with the shoes, and two additional pairs of inserts.

    How Much Will Diabetic Shoes Cost?

    Please contact Arizona Prosthetic Orthotic Services to receive more information based on your individual circumstances.

    What is the Statement of the Certifying Physician?

    The physician managing the patient's systemic diabetic condition must submit a statement of certification for the therapeutic shoes. The following is a suggested format:

    I certify that all of the following statements are true:
    1. This patient has diabetes mellitus.
    2. This patient has one or more of the following conditions:

    • History of complete or partial amputation of the foot
    • History of foot ulceration
    • History of pre-ulcerative calluses
    • Peripheral neuropathy with evidence of callus formation
    • Deformity of either foot (for example, hammertoe or bunions)
    • Poor circulation
    3. I am treating this patient under a comprehensive plan of care for his/her diabetes.
    4. This patient needs special shoes and/or inserts because of his/her diabetes.

    This statement can be prepared by the prescriber or supplier, but must be reviewed and signed by the certifying physician. The certifying physician must be an M.D. or D.O., not a podiatrist.

    Who is the Prescribing Physician?

    Along with the statement of certification, a prescrption is neccessary for therapeutic shoes and inserts. This prescription may be written by the physician who provided the statement, or b a podiatrist or other qualified physician.

    Who can furnish the footwear?

    When the statement of certification and prescription have been prepared, the footwear may be provided by an orthotist, prosthetist, podiatrist, pedorthis, or other qualified individual. The certifying physician may be a provider only if the patient is residing in a defined rural area or defined heath professional shortage area.