Therapeutic Shoes for Persons with Diabetes - Policy Article

Medicare covers therapeutic shoes, stated modifiers, inserts and modifications for beneficiaries with diabetes mellitus only when specific clinical foot risk factors are documented and the certifying physician (MD/DO) certifies need and treatment under a comprehensive diabetes plan. Required documentation includes a prior Standard Written Order, in-person visits/evaluations within specified timeframes (generally within 6 months for evaluation and within 3 months for certification signature), supplier objective fit assessment at delivery, and adherence to annual quantity limits and HCPCS/coding requirements (e.g., KX modifier); specified items (e.g., A5510, A5508) and quantities beyond the annual limits are noncovered.

"Beneficiary has diabetes mellitus documented in the medical record."

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