Telehealth Fulfills Certifying Requirement for Diabetic Shoes, Face-to-Face Required for Shoe Fitting

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The American Orthotic and Prosthetic Association (AOPA) confirmed with the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) that physicians, including doctors of medicine (MDs) and doctors of osteopathic medicine (DOs), may use telehealth to fulfill face-to-face encounter requirements when certifying the medical need for diabetic shoes during the COVID-19 public health emergency (PHE). Suppliers of diabetic shoes, including orthotists, prosthetists, and pedorthists, will still be required to perform an in-person evaluation at the time of shoe selection and an in-person fitting of the shoes at delivery. Prior to the PHE, Medicare coverage of therapeutic shoes required in-person visits with the certifying physician and the supplier of the shoes.

 

On April 6, the Centers for Medicare & Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) that indicated for claims with dates of service on or after March 1, "requirements for face-to-face or in-person encounter for evaluations, assessments, certifications or other implied face-to-face services would not apply during the COVID-19 PHE."

 

A May 7 DME MAC article said that the IFC-based waiver of face-to-face encounter requirements only applied to policy-based requirements and not to face-to-face encounter requirements that are memorialized elsewhere, such as in the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Quality Standards or Social Security Act. According to AOPA, this led to significant questions, especially related to Medicare coverage of therapeutic shoes.