Clarification of Criterion 5 - JA DME

Per the Local Coverage Determination (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."

Additionally, the Policy Article (PA) provides further clarification by stating, "At the time of in-person delivery to the beneficiary of the items selected, the supplier must conduct an objective assessment of the fit of the shoe and inserts and document the results. A beneficiary's subjective statements regarding fit as the sole documentation of the in-person delivery does not meet this criterion."

The following questions and answers will assist to determine if an objective assessment of the fit of the shoes and the inserts is properly documented by the supplier at the time of delivery.

Q1: Does the documentation need to indicate the beneficiary is wearing the shoes and inserts?"
A1: Yes. The supplier must conduct the in-person evaluation at the time of delivery with the beneficiary wearing the shoes and inserts.

Q2: Does the objective assessment include the therapeutic shoes and inserts?
A2: Yes. Suppliers must document that the shoes/inserts/modifications fit properly at the time of delivery.

Q3: Are the following comments such as, "good fit", "fits well", or "beneficiary states shoes are comfortable" examples of objective documentation?
A3: No. Per the PA, a beneficiary's subjective statement regarding fit as the sole documentation of the in-person delivery does not meet this criterion. Suppliers must objectively document the assessment of the fit of the shoes and inserts to indicate how the shoes were a "good fit."