Understanding Telehealth Visits for the Therapeutic Shoe Benefit: Key Criteria and Guidelines

As telehealth continues to play a crucial role in healthcare delivery, many suppliers are receiving questions about its application to the Therapeutic Shoe benefit for individuals with diabetes. This benefit is designed to provide necessary footwear to those at risk of complications due to their condition. However, specific criteria must be met for coverage, particularly in relation to the certifying physician's involvement.

Overview of the Therapeutic Shoe Benefit

The Therapeutic Shoes for Persons with Diabetes program is aimed at preventing complications such as foot ulcers and amputations in diabetic patients. To qualify for this benefit, healthcare practitioners must adhere to strict guidelines, which may include both in-person and telehealth visits. Understanding these criteria is essential for both providers and beneficiaries to ensure proper coverage and care.

  • Criteria 2, must be in person: The certifying physician must document in the beneficiary's medical record at least one of the following qualifying conditions:
    • Previous amputation of the other foot or part of either foot
    • History of 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
    To meet criteria 2, the visit must be in person with the practitioner.
  • Criteria 3, may be a telehealth visit: The certifying physician has certified that indications (1) and (2) are met and that he/she is treating the beneficiary under a comprehensive plan of care for his or her diabetes and that the beneficiary needs diabetic shoes
    To meet criteria 3, the visit may be a telehealth visit with the practitioner.
  • Criteria 4 and 5 are roles the supplier plays and these both must be in person visits with the supplier.
Last Updated Dec 16 , 2024