Therapeutic Shoes - JA DME
Therapeutic Shoes for Persons with Diabetes
The Standard Written Order (SWO) requirements are in effect for dates of service January 1, 2020 and after.
Refer to the SWO page for the elements needed in this streamlined order.
Coverage
- Therapeutic Shoes for Persons with Diabetes Local Coverage Determination (LCD) and Policy Article [PDF]
Documentation
- Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Physician Letter - Documentation Requirements [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Statement of Certifying Physician for Therapeutic Shoes
- Therapeutic Shoes for Persons with Diabetes Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required documentation
Reviews/Audits
- Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review
Tips
Topic | Details |
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Criteria 2 |
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Criteria 3 |
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Criteria 4 |
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Criteria 5 |
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Nurse Practitioners and Physician Assistants as Certifying Physicians for Therapeutic Shoes and Inserts |
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RT/LT Modifiers |
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Primary Care First Model Demonstration Project - Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts |
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Resources
- Clarification of Criterion 5 - Per the LCD, "The in-person evaluation of the beneficiary by the supplier at the time of delivery…must be conducted with the beneficiary wearing the shoes and inserts and must document that the shoes/inserts/modifications fit properly."
- PDAC Coding Guidelines for Off-the-Shelf Diabetic Shoes (A5500) - The information presented in this article comes from the Therapeutic Shoes for Persons with Diabetes Local Coverage Determination (L33369) and related Policy Article (A52501), coding language, coding guidelines, and assessment of samples that have been submitted to the PDAC for Code Verification Review.
- Toe Fillers and Diabetic Shoe Inserts - Shoe inserts for beneficiaries with missing toes or partial foot amputations who are not diabetic are considered for coverage under the prosthetic benefit
Last Updated Wed, 27 Jan 2021 20:26:21 +0000
Related Articles
The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.