Therapeutic Shoes for Persons with Diabetes: CERTFindings and Documentation Requirements
Medicare covers therapeutic shoes, inserts, andmodifications for beneficiaries with diabetes when all statutory and policyrequirements are met. Coverage requires certification by a physician managingthe beneficiary’s diabetes, and documentation supporting that the beneficiarymeets all coverage criteria. Claims that do not meet these requirements will bedenied.

Therapeutic shoes remain an area of focus for ComprehensiveError Rate Testing (CERT) due to a high volume of claims denied fordocumentation‑related errors. In many cases, CERT improper payment findings arethe result of missing, incomplete, or invalid documentation rather than lack ofbeneficiary eligibility.

Common causes of improper payments for therapeutic shoes:

• Missingor insufficient documentation of a qualifying foot condition
• Missingor insufficient documentation that the certifying physician is managingthe beneficiary’s diabetes
• Invalidor incomplete Standard Written Orders (SWOs)
• Invalidor missing Statement of the Certifying Physician
• Insufficientdocumentation to support insert or modification coding

During a CERT review, claims are evaluated based on thedocumentation submitted. If the required documentation is not provided or doesnot clearly support coverage criteria, the claim is considered non‑payable.

Suppliers are responsible for ensuring that requireddocumentation is obtained, reviewed, and maintained prior to claim submission.Documentation must include:

• Adocumented diagnosis of diabetes mellitus
• Documentationof at least one qualifying foot condition
• Certificationthat the physician is treating the beneficiary under a comprehensive planof care for diabetes
• Avalid Standard Written Order (SWO)
• Aproperly completed and timely Statement of the Certifying Physician

Documentation must be clear, legible, andavailable upon request. Failure to meet these requirements may result in claimdenial, overpayment recovery, or additional review. Refer to the Therapeutic Shoes for Persons with Diabetes Documentation Checklist to assist with ensuring the proper documentation has been obtained for payment.