May 1, 1993 Medicare determined that therapeutic footwear and protective insoles were effective methods for preventing foot problems among Diabetic patients. Therapeutic footwear and protective insoles provide protection that helps reduce callusing which can lead to ulcerations. Under their Therapeutic Shoe Bill benefits, the patient receives one pair of Extra Depth shoes and three pair of Protective Inserts once every calendar year. This extra level of protection will help keep diabetic patients out of the hospital and off the operating table.

According to Medicare’s guidelines an Extra Depth shoe:

• is one that 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;
• is made from leather or other suitable material of equal quality;
• has some form of shoe closure such as lace or Velcro;
• 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. This includes a shoe with or without an internally seamless toe.

A diabetic shoe insert is a total contact, multiple density, removable inlay that is directly molded to the patient’s foot or a model of the patient’s foot and made of a suitable material with regard to the patient’s condition. The molding of the insert must be accomplished by an external heat source, for example, an oven or heat gun.

Requirements:
Diabetic shoes, inserts and/or modifications to the shoes are covered if the following criteria are met:

  1) The patient had diabetes mellitus (ICD-9-CM diagnosis codes 250.00-250.93);
  2) The patient has one or more of the following conditions:

• Previous amputation of the other foot, or part of either foot,
• History of previous foot ulceration of either foot,
• History of pre-ulcerative calluses of either foot,
• Peripheral neuropathy with evidence of callus formation of either foot,
• Foot deformity of either foot,
• Poor circulation in either foot;

The certifying physician who is managing the patient’s systemic diabetes condition has certified that indications (1) and (2) are met and that he/she is treating the patient under a comprehensive plan of care for his/her diabetes and that the patient needs diabetic shoes. According to the Medicare Region C DMEPOS Supplier Manual this statement must be signed by a primary care physician, not a podiatrist.

There is a printable copy of the Statement of Certifying Physician available below.

Print Out A Statement of Certifying Physician
(.PDF Document 227Kb)