CG-DME-19 Therapeutic Shoes, Inserts, or Modifications for Individuals with Diabetes

This policy addresses therapeutic shoes, inserts, and shoe modifications for individuals with diabetes. Coverage is medically necessary when the individual has diabetes and at least one of the following: prior foot/partial foot amputation, history of foot ulcer, pre-ulcerative calluses, peripheral neuropathy with loss of protective sensation with evidence of callus, foot deformity, or peripheral vascular disease of the treated foot. Shoes, inserts, or modifications that do not meet these criteria are not medically necessary.

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