Therapeutic Shoes - JD DME
Therapeutic Shoes for Persons with Diabetes
Coverage
- Therapeutic Shoes for Persons with Diabetes Local Coverage Determination (LCD)
- Therapeutic Shoes for Persons with Diabetes Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Therapeutic Shoes for Persons with Diabetes [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Medical Records [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Clinician Letter - Therapeutic Shoes For Persons With Diabetes: Physician 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
Practitioner Activity Timeline
Activity | Practitioner | Requirements |
---|---|---|
Visit to document diabetes mellitus management | Certifying MD/DO, NP/PA "incident to", NP PCF Demonstration Project | Within 6 months prior to delivery |
Visit to document qualifying foot condition | Certifying MD/DO, other MD/DO, Podiatrist, PA, NP, CNS | Within 6 months prior to delivery |
Complete the Certification Statement | Certifying MD/DO, NP/PA "incident to" supervising MD/DO must verify (sign/date), NP PCF Demonstration Project |
|
Sign the SWO | Treating Practitioner: Certifying MD/DO, other MD/DO, Podiatrist, PA, NP, CNS | After visit with the treating practitioner |
Supplier Activity Timeline
Activity | Supplier | Requirements |
---|---|---|
Selection Visit | Supplier | Prior to selecting the specific items that will be provided |
Fit Assessment/Delivery Visit | Supplier | After selection visit |
Claim Submission | Supplier |
|
NP or PA as Certifying Physician
NP Participant of PCF Model Demonstration Project | NP or PA Practicing "incident to" Certifying Physician |
---|---|
Acts as certifying physician | Acts as certifying physician |
Performs exam | Performs exam |
Documents in medical record | Documents in medical record, certifying physician signs, dates and indicates agreement |
Completes certification statement | Completes certification statement, certifying physician co-signs |
Tips
Topic | Details |
---|---|
Criteria 2 |
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Criteria 3 |
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Criteria 4 |
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Criteria 5 |
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Medicare Coverage for Shoes - Correct Coding - Revised |
Medicare has limited coverage provisions for shoes, inserts, and shoe modifications used by beneficiaries. In order to be eligible for coverage, such items must qualify in either:
|
Nurse Practitioners and Physician Assistants as Certifying Physicians for Therapeutic Shoes and Inserts |
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Partial Foot, Shoe Insert (Toe Fillers), and Shoe Inserts for Diabetics - Coding Based on Benefit Category - Correct Coding | Guidance for billing Partial Foot, Shoe Insert (Toe Fillers) , and Shoe Inserts for Diabetics |
Primary Care First Model Demonstration Project - Nurse Practitioners as Certifying Physicians for Therapeutic Shoes and Inserts |
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RT/LT Modifiers |
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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.
Last Updated Thu, 23 Mar 2023 18:50:40 +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.