Medicare established the Diabetic footwear benefit to lower
the incidence of diabetic foot complications such as ulceration
and amputation in the diabetic population. Due to the preventive
nature of this program, a patient may qualify for shoes and inserts
without a history of any foot complications.
To qualify for the benefit, the following criteria must be met:
1. The patient has type I or type II diabetes mellitus (diagnosis
codes 250.00-250.93) either insulin dependent or dietary controlled.
2. The patient has one or more of the following conditions:
a) Previous amputation of the other foot, or part of either foot.
b) History of previous foot ulceration of either foot.
c) History of pre-ulcerative calluses of either foot.
d) Peripheral neuropathy with evidence of callus
formation of either foot.
e) Foot deformity of either foot. (At this time Medicare has not
stated what type of foot deformity needs to be present.
However, you may infer that it would be a deformity that
could cause a problem if the patient was not wearing a
properly fitted shoe and molded insert.)
f) Poor circulation in either foot.
3. The certifying physician who is managing the patient's
systemic diabetes condition has certified that:
a) The indications listed in (1) and (2) are present.
b) The physician is treating the patient under a
comprehensive plan of care for his/her diabetes.
c) The patient needs diabetic shoes.
The above information for each patient is documented on the
Statement of Certifying Physician Form. The certifying physician
(M.D. or D.O.) in completing the form certifies medical necessity
for the service. This statement may be completed by the
prescribing physician or supplier (podiatrist) but must be
reviewed for accuracy and signed by the certifying physician
(M.D. or D.O.) to indicate agreement.
