Medicare

Medicare Benefits For Diabetic Footwear

Here we will take on all your questions about Medicare Benefits for Diabetic Footwear.
Don’t see the information you’re looking for? Feel free to Ask A Pedorthist, Or you can call, stop in or email us for an answer. We’re always glad to help! Click Here for our contact information.

What is Medicare’s therapeutic shoe bill and who qualifies for these benefits?
A. According to the Centers for Disease Control and Prevention (CDC) 60% of non-traumatic amputations occur in people with diabetes and about 82,000 lower limb amputations are performed each year on people with diabetes.

The American Podiatric Medical Association (APMA) reported that shoes which are poorly fit are involved in about half of problems that lead to these amputations.

In May 1993, Medicare started to provide partial reimbursement for depth shoes, custom molded shoes and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes. The goal of this program is to prevent foot problems for those patients who are at risk.

To qualify for these benefits a person must meet the following criteria:

1) You must be covered by Medicare.

2)The doctor who is responsible for diagnosing and treating your diabetes must state the following in writing:

A) You have diabetes.
B) Special shoes are required as part of your treatment plan.
C) You now have or have had one of the following conditions:
1) Peripheral neuropathy with evidence of callus formation.
2) History of pre-ulcerative calluses.
3) Foot deformity.
4) Previous amputation of the foot or part of the foot.
5) Poor circulation.
6) History of previous ulceration.

3) A Certificate of Medical Necessity form must be filled out by the doctor managing your diabetes.

Fitting a person with diabetes with proper footwear is not simple. The pedorthist must be able to make the needed modifications to the shoes and inserts to avoid pressure points that can lead to blisters, calluses, corns, ulcers and amputation.

At Cobbler’s Corner we have 3 certified pedorthists and 4 professional shoe fitters on staff. Remember, a shoe fit is as personal as the sound of a person’s voice.

Make sure your footwear, instead of being part of the problem, is part of the healthy solution!

For more information about our pedorthic facility, retail store, shoe repair facility and orthotic lab, or to learn more about the Medicare Shoe Bill or how we can help you get on the road to healthy feet. Please stop in or call.
Click Here to Contact Us.

What do I need to do to apply for reimbursement under Medicare’s Therapeutic Shoe Program?
There are 4 brief forms which Medicare requires.

Two of these are for the prescribing doctor:

1. An information sheet explaining the requirements for prescribing medicare approved footwear. This form is to be taken to the doctor’s office by the patient and kept by the prescribing physician.

2. A Medical Necessity Form to be taken to the doctor’s office by the patient and filled out by the prescribing physician then returned to the patient.
This form, along with the patient’s Medicare card is then taken, by the patient, to a Certified Pedorthist.
Here, a copy of the patient’s medicare card will be made and kept in the patient’s file at the Pedorthic Facility and the completed form will be used to submit a claim to Medicare.
IMPORTANT: This form is your prescription for Medicare approved footwear! Your Pedorthist CAN NOT

The other two forms are for the patient receiving the prescribed footwear:

1. A Medicare insurance form to be filled out by the patient or their legal guardian, then signed and returned to the Certified Pedorthist.
This form authorizes the Pedorthist to bill Medicare on the patient’s behalf.

2. A patient information form which certifies that the patient has received proper instruction for the use and care of the prescribed footwear.
This form is to be read and understood by the patient or their legal guardian, then signed and returned to the Pedorthist to be placed in the patient’s file.

Where can I find the forms I need to apply for Medicare’s Therapeutic Shoe Program?
Where can I find the forms I need to apply for Medicare’s Therapeutic Shoe Program?

At Cobbler’s Corner, we have made it simple for you to find the forms you will need for Medicare’s Therapeutic Shoe Program.
Just drop by our facility any time during regular business hours and we will be happy to provide you with these forms.

If you are unable to come to Cobbler’s Corner, you can find Medicare Forms Here and throughout our website, and you will be redirected to a page of printable medicare forms which you can download to your computer or print directly from that page.

Cobbler’s Corner is the only State Certified, Nationally Accredited Pedorthic Facility in the tri-state area. We have 3 Certified Pedorthists with appointments available 5 days a week. To schedule an appointment with one of our Certified Pedorthists, just stop by or give us a call.

Click Here to Contact Us.

How much will Medicare pay for my footwear and/or orthotics, and when and how do I get paid?
Medicare has the following reimbursement schedule to reimburse the patient after receiving his/her prescribed shoes and orthoses from an authorized Medicare provider.

    • 80% of $123.82 on Shoes
    • 80% of $75.38 on Orthotic Devices
    • 80% of $371.40 on Custom Made Shoes

Please Note the following:
1). Medicare does not make payment directly to the Medicare provider. The patient must pay for the footwear and any necessary adjustments, then await reimbursement from Medicare.

2). These figures are guidelines only. Medicare frequently deviates from these amounts on an individual case basis. The exact amount of reimbursement can not be known until Medicare approves the claim.

3).You must have a prescription from a doctor before receiving your shoes and orthotic devices. The prescription must have a diagnosis regarding your diabetes and one of the 6 following conditions and the Rx for extra depth orthopedic shoes and accommodative orthotic devices.

    1. History of partial or complete amputation of the foot
    2. History of previous foot ulceration
    3. History of pre-ulcerative callus
    4. Peripheral neuropathy with evidence of callus formation
    5. Foot deformity
    6. Poor circulation
      Please be aware – It is common practice among providers to inflate the value of their footwear in order to attempt to get more money from Medicare. If you seem to be getting an incredibly good deal, chances are, you’re getting ripped off. Recently, we had a client bring us a modestly priced pair of shoes with off-the-shelf orthotics which the provider had claimed were worth $700.00! The client came to us because they were not helping his feet.

We do not change the price of our footwear or our services for Medicare claims. We always strive to give our clients the most for their money. That includes quality products, quality service and individual attention. If some one else offers to do what we do for substantially less money,
THEY ARE LYING!

Cobbler’s Corner is a State Certified, Nationally Accredited Pedorthic Facility. To schedule an appointment with one of our 3 Certified Pedorthists, use the form found here.

Do I have to buy one special style of shoe to qualify for reimbursement from Medicare?
Do I have to buy one special style of shoe to qualify for reimbursement from Medicare?

No. If you have Medicare Part B, have diabetes, and meet certain conditions (more details here), Medicare will cover therapeutic shoes if they meet the following standards.

Depth Shoes:

A depth shoe (A5500) is one that
1) has a full length, heel-to-toe filler that when removed provides a minimum of 3/16″ of additional depth used to accommodate custom-molded or customized inserts;
2) is made from leather or other suitable material of equal quality;
3) has some form of shoe closure; and
4) is available in full and half sizes with a minimum of three widths so that the sole is graded to the size and width of the upper portions of the shoe according to the American standard last sizing schedule or its equivalent. (The American last sizing schedule is the numerical shoe sizing system used for shoes in the United States.) This includes a shoe with or without an internally seamless toe.

Custom-molded shoes:

A custom-molded shoe (A5501) is one that
1) is constructed over a positive model of the patient’s foot;
2) is made from leather or other suitable material of equal quality;
3) has removable inserts that can be altered or replaced as the patient’s condition warrants; and
4) has some form of shoe closure. This includes a shoe with or without an internally seamless toe.

There are many footwear choices available which meet Medicare’s standards. These are available in a variety of styles from various manufacturers.

It should be pointed out, however, that Medicare is very specific as to the amount of reimbursement they offer for diabetic footwear (more details here). Since footwear styles can vary widely in price, one should keep this in mind when shopping for Medicare approved shoes.

Cobbler’s Corner carries a wide selection of Medicare approved footwear in various sizes, styles and colors, and from several different manufacturers, such as Aetrex, Drew and New Balance. To see some of the styles available, follow this link, Medicare Approved Diabetic Footwear, to our diabetic footwear page.

If you would like to drop by and see us, we will be glad to discuss your options with you. Just visit our store in Columbiana, OH, to speak with a professional shoe fitting specialist or schedule an appointment with one of our Certified Pedorthists. Just follow this link:
Contact Info, Location, Hours and Appointment Times.

What is Cobbler’s Corner’s Policy concerning Medicare approved footwear?
Medicare approved diabetic footwear policy:

Footwear Fitting:

At Cobbler’s Corner, we constantly strive to provide our clients with the highest standard of customer service. All Medicare approved footwear which we sell is individually fitted by one of our professional shoe fitting technicians and, in the case of a shoe fitting for a person with diabetes, fitting is supervised by a certified pedorthist.

Adequate, properly fitted footwear is a very important part of diabetes management. Therefore, ALL diabetic clients must come to our facility for an inspection of their feet to determine any potential trouble spots and/or the need for shoe modification or orthotics. Diabetics are at extreme risk for serious foot disorders. Calluses, corns, sores and ulcers on the feet are usually caused by improper footwear and can lead to infection. An infection can result in far more serious consequences, possibly including amputation. Studies show that well fitted diabetic shoes and insoles reduce the development of these problems.
By starting preventive measures early, it is possible to avoid later foot complications and enable you to maintain an independent, active lifestyle.

Pricing Policy:

We always provide our footwear and services at the same cost to everyone regardless of whether the client has Medicare or not. We will not change our prices or the quality of our products and services in order to “cash in” on Medicare or any other type of program.

Medicare Assignments:

Because of our determination to maintain the highest quality standards and due to reductions in Medicare’s reimbursement for diabetic footwear, we no longer accept assignments for the Medicare Therapeutic Shoe Program. Payment for footwear, insoles and/or other devices is due at the time of service.

Our goal is to continue providing you with the highest quality footwear, insoles and service available. WE REFUSE TO LOWER OUR STANDARD OF QUALITY FOR THE FOOTWEAR WE PROVIDE OR OUR LEVEL OF CARE DUE TO REDUCED REIMBURSEMENT AMOUNTS FROM MEDICARE! YOU, OUR CLIENT, DESERVE AND WILL RECEIVE THE BEST PRODUCTS AND SERVICE AVAILABLE TO MEET YOUR NEEDS!

Keeping your feet healthy is YOUR responsibility. We are here to help keep your feet on the road to good health by offering you the best products and service available.

Always here to answer your questions.

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