WebThe documentation must clearly indicate that (1) the patient is being treated for diabetes mellitus and (2) the patient has one of the following qualifying conditions: Previous amputation of the other foot, or part of either foot, or History of previous foot ulceration of either foot, or History of pre-ulcerative calluses of either foot, or http://www.dncshoes.com/diabeticshoeprescription.pdf

CGS Medicare

WebDec 9, 2024 · requirements in their provision of therapeutic shoes to beneficiaries with diabetes if all of the following criteria are met: 1. The supervising physician has documented in the medical record that the beneficiary is diabetic and has been, and continues to provide, the beneficiary follow-up under a comprehensive management program of that … WebDec 21, 2024 · Diabetic shoes can be costly because they’re specialty shoes and need to be custom-fitted for your feet. On average, diabetic shoes can range in cost from $50-$200 per pair . Your out-of-pocket … cuh mychart

Certifying Physician Statement for Therapeutic Shoes for …

WebI certify that all of the following statements are true: 1. This patient has diabetes mellitus. 2. This patient has one or more of the following conditions. (Circle all that apply): a) History of partial or complete amputation of the foot b) History of previous foot ulceration c) History … Web2. Statement of Certifying Physician • Within 3 months of delivery of shoes and inserts and Inserts 3. Diabetic Foot Exam • If not completed by MD/DO, MD/DO must sign-off and indicate agreement by other • Within 6 months of delivery 4. Prescription for Therapeutic Shoes • Detailed Written Order 5. Proof of Delivery/Warranty/Break In WebCoverage of therapeutic shoes for persons with diabetes is based on Social Security Act §1862(a)(1)(A) provisions (i.e. “reasonable and necessary”) and coverage of therapeutic shoes and inserts under the Therapeutic Shoes for Individuals with Diabetes benefit (Social Security Act §1861(s)(12)). In addition, eastern michigan bank croswell hours