An Explanation of Benefits - Medicare's Therapeutic Shoe Benefit
The Centers for Disease Control and Prevention (CDC) estimates that 23.1-million Americans have been diagnosed with diabetes. Studies have shown that 25 percent of persons with diabetes develop foot problems related to the disease and that up to 15 percent of persons with diabetes develop foot ulcers.
Since 1993, Medicare has covered certain therapeutic shoes, inserts and modifications for persons with diabetes who meet specified qualifying requirements.
Medicare covers diabetic shoes, inserts and modifications for program beneficiaries only if the following criteria are met*:
(a) The patient has diabetes and one or more of the following conditions:
(b) The patient has a prescription for a particular type of footwear (e.g., shoes, inserts, modifications) from a podiatrist or physician who is knowledgeable in the fitting of diabetic shoes and inserts.
(c) A "Statement of Certifying Physician for Therapeutic Shoes" from a physician who manages the patient's diabetes, which certifies that the patient (a) has diabetes mellitus, (b) has at least one of the qualifying conditions (see above), (c) is being treated under a comprehensive plan of care for his or her diabetes, and (d) needs diabetic shoes.
What is Covered?*
For Medicare beneficiaries meeting the criteria described above, coverage is limited to one of the following within 1 calendar year:
Additional requirements may apply. You should consult a qualified expert or your Medicare program representative for details.
* As noted by the PDAC
The information contained herein is a summary of Apex's understanding of select Medicare rules and policies, and is intended for information purposes only. Persons and entities participating in the Medicare program are responsible for understanding all applicable Medicare policies before submitting claims for payment to the program, and you should use this publication only as a guide. Failure to comply with such rules and requirements can have serious consequences. For comprehensive or authoritative guidance, please consult Medicare program representatives and publications or your counsel.
Foot care tips everyone should know!
Foot Pain is NOT Normal
Your feet should mirror your general health. With the right fit, proper footwear and orthotics for your foot type, most common foot pain can be relieved and prevented.
Buy Shoes that Fit Your Needs
Most people do not know their true foot size (length and width) and too often purchase shoes that are too small. Today, many full-service stores are equipped with foot-scanning technology that is able to capture your foot size, arch type and pressure points and recommend the ideal footwear and orthotics for your needs.
Give Your Feet a Break
While we love our heels, women have four times as many foot problems as men and high heels are partly to blame. Whenever possible, wear comfortable shoes that fit your feet properly.
After being on your feet all day, give your feet a little TLC. Knead them gently with your thumbs to increase blood circulation. Then cover them with a good quality foot cream or nourishing gel to help keep the skin from cracking and drying.
Socks are Important Accessories
Socks are important foot health accessories too. Damp and dark conditions, such as those found in shoes, promote the growth of fungi, bacteria and odor. Protect your feet by wearing socks made with copper fibers that have been clinically proven to help eliminate these common problems and improve your skin’s appearance and texture.
Sites such as foot.com offer comprehensive information about foot conditions, sports injuries, foot health for diabetes, and an online shop with products that help treat or prevent foot pain.
*Always consult your podiatrist or physician if you suffer from persistent pain or a medical condition