AOPA Answers
Shoe Walk-Through Answers to your questions regarding therapeutic shoes and inserts AOPA receives hundreds of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers. If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@strattonpublishing.com.
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Can the supplier of therapeutic shoes complete the certifying statement as long as it is signed and dated by the certifying physician? No. The Medicare Local Coverage Determination for Therapeutic Shoes indicates the certifying statement must be “completed, signed, and dated by the certifying physician.”
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Is the certifying statement considered enough documentation to support the medical need for diabetic shoes?
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Unfortunately, no. The Medicare Therapeutic Shoe Policy Article notes that the certification statement alone does not meet the documentation requirements for coverage. The policy article clearly outlines what must be present in the certifying physician’s medical records to support your claim. The certifying physician must personally document the occurrence of an in-person evaluation of the patient within six months of delivery of the shoes. The documentation of this visit must include the confirmation of at least one of the secondary conditions required in the policy for Medicare coverage of therapeutic shoes; this secondary condition can be documented by the certifying physician, or the certifying physician may “obtain, initial/sign, date, and indicate agreement with the records of another M.D., D.O., physician assistant, nurse practitioner, or clinical nurse specialist.”
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O&P Almanac AUGUST 2012
Can all three sets of inserts for a calendar year be dispensed at the same time as the shoes?
Yes, as long as the patient has been instructed to rotate the use of the inserts so they wear evenly. No item is covered by Medicare unless it is deemed to be medically necessary. If the patient is instructed to use one set of inserts until it is worn out and then use a second pair, the medical need for the second pair is not established until the first pair is used. If the patient is instructed to rotate the inserts, then they are deemed to be medically necessary when the shoes are dispensed.
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If I did not provide the shoes, may I provide inserts?
Yes—in limited circumstances. In order for Medicare to cover inserts provided independently of therapeutic shoes, the provider of the inserts must obtain a written statement from the provider of the shoes that the patient has appropriate footwear into which the inserts may be placed. a