Medicare Therapeutic Shoe Bill: A Synopsis

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By Séamus Kennedy, BEng (Mech), CPed

The Medicare Therapeutic Shoe Bill was enacted by Congress in order to provide proper footwear and inserts for people with diabetes who qualify under Medicare Part B. The program was designed to prevent lower limb ulcers, amputations, and other complications in people who suffer from the disease. Eligible patients qualify for one pair of shoes, plus extra pairs of inserts and/or shoe modifications for each calendar year.

Many of the extra-depth and custom-molded shoe companies have designed specific programs to meet this bill, which ensure that the patient gets excellent foot protection and that you can still make a fair profit. Medicare will reimburse for 80 percent of the amount allowed, and the patient is responsible for a minimum of 20 percent. The billing codes and allowables for this program are listed in Table 1.

In order to qualify for the program, certain criteria must be met. First, the doctoran MD or DOtreating the diabetes must fill out the "Statement of Certifying Physician" (see Table 2). A copy of this certificate must be kept in the patient's chart. Second, you need a prescription for the necessary footwear from the doctor who is treating the foot condition.

You, as a qualified individual, may then provide the footwear. As a supplier, you need to have a National Supplier Number in addition to your Medicare provider number. New paperwork and prescriptions are required for the replacement of shoes or inserts. It is also important to note that a "KX" modifier should be used on your claims to indicate that you have an up-to-date prescription and Statement of Certifying Physician on file.

This is a general outline of the Therapeutic Shoe Bill. There are several websites that offer more specific information on the coding, billing, and shoe choices. Two good examples of sites where you can obtain more details are: www.safestep.net and www.surefitlab.com

Séamus Kennedy, BEng (Mech) CPed, is president and co-owner of Hersco Orthotic Labs, Long Island City, New York. He is a regular speaker on manufacturing and fitting of custom shoes and orthotics.