Medicare Therapeutic Shoe Program

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 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.

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) separate inserts are covered under certain criteria; 2) shoe modifications are covered as a substitute for an insert; and 3) custom molded shoes are covered when the patient has a foot deformity which 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 must review and sign a "Statement of Certifying Physician for Therapeutic Shoes", and the prescribing physician must complete a footwear prescription.  Once the patient has the necessary documentation, he/she can see a 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 Medicare patients.  PLEASE NOTE: Suppliers may not be able to dispense or submit claims for these devices to HMO Medicare patients without approval from their PCP. Patients in hospitals or Skilled Nursing Facilities are also excluded from this program.

to use these forms just click... and print

Here is the form you will need to take to your doctor

Here's a handy check list of what you will need when you come visit us.

Patient Payment
The Health Care Financing Administration (HCFA) will reimburse 80% of the amount it designates as "allowable", with the patient responsible for a minimum of 20% of the total payment amount. This 20% may be covered by secondary or supplemental insurances if applicable.  If the dispenser/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: Many suppliers do not accept assignment because they consider the allowable amount too low to cover the appropriate materials and services.  This means the total cost to the patient may be higher than the allowable amount and the patient is usually expected to pay in full, prior to receiving any Medicare reimbursement.

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 American Board for Certification in Orthotics and Prosthetics.

Foot Pain Relief Store has 2 Board Certified Pedorthists on staff.

If you have any questions please call one of our friendly Foot Pain Relief Store associates today. we are more then glad to answer any questions you may have!