Diabetic Shoes and Foot Orthotics

Medicare covers therapeutic shoes and inserts for persons with diabetes. This statutory benefit is limited to one pair of shoes and up to 3 pairs of inserts or shoe modifications per calendar year. The following documentation is required in order for Medicare to pay for diabetic shoes and inserts and must be provided by the physician to Brunswick O&P: 

​

1. A standard written order (SWO) or Prescription. 

This may be prepared by the Brunswick O&P but must be reviewed and signed by a physician to indicate agreement. The SWO must be signed on or after the date of the visit with the physician. 

​

2. A copy of an office visit note, from the patient’s medical record, that shows management of the patient’s diabetes. 

This office visit must occur within 6 months prior to delivery of the shoes and inserts. 

​

3. A certification form stating that the coverage criteria has been met. (TRX) 

This form must be completed, signed, and dated by the certifying physician after the visits described in #2 and #4 and within 3 months prior to delivery of the shoes/inserts. A new TRX is required for a shoe, insert or modification provided more than one year from the most recent TRX on file. This form is not sufficient by itself to show that the coverage criteria have been met and therefore must be supported by other documents in the patient’s medical record, as noted in #2 and #4. The TRX must be signed on or after the date of the visit with the physician. You may download the form below and bring it to your physician.

 

​

​

4. A copy of an office visit note, from the patient’s medical record, that describes one of the qualifying conditions listed in the TRX above.  

This office visit note may document an interaction between the patient and the certifying physician or the patient and another qualified practitioner (such as a podiatrist, NP, PA, or certified nurse specialist [CNS]). If seen by a podiatrist, NP, PA, or CNS, then the certifying physician must sign, date, and make a note on that document indicating agreement and send that to the Brunswick O&P.

​

​

​

​

New documentation is required yearly in order for Medicare to pay for replacement shoes and inserts. As well, a new order is required for the replacement of any shoe. A new order is also required for the replacement of an insert or modification more than one year from the most recent order on file. 

 

For additional information regarding coverage, billing, and documentation requirements, review the complete Therapeutic Shoes for Persons with Diabetes LCD ( https://www.cms.gov/medicare-coverage-database/details/lcd- details.aspx?lcdid=33369 ) and the related Policy Article ( https://www.cms.gov/medicare-coverage- database/details/article-details.aspx?articleid=52501 ) located in the Medicare Coverage Database at http://www.cms.gov/medicare-coverage-database