Medicare Reimbursem*nt: An Explanation of Benefits
Nearly 30 million Americans have diabetes, according to theCenter for Disease Control. In fact, studies suggest prescription diabetic footwear can help prevent serious foot health complications that can arise because of diabetes.
Medicare and supplemental insurance may reimburse part or all the cost of Dr. Comfort shoes and prescription inserts for diabetics who meet certain criteria. A qualified health professional can determine if eligible. If diabetic or have any foot health concerns, we strongly encourage the patient to see a foot health professional to address all foot health needs.
Medicare’s Diabetic Shoe Benefit
In May 1993, congress passed the Therapeutic Shoe Bill (TSB). Since then,Medicare Part B(Medical Insurance) provides reimbursem*nt oftherapeutic shoes,insertsand modifications for those living with diabetes who meet specified qualifying requirements.
Who’s Eligible for Diabetic Shoes?
Coverage is for anyone with Medicare Part B (or other qualified insurance) who has diabetes, has appropriate documentation from a qualified physician, and:
- Previous amputation of the foot, or part of either foot, or
- History of ulcers, or
- History of pre-ulcerative calluses, or
- Diabetic Neuropathy with evidence of Callus formation, or
- Foot deformity, or
- Poor blood circulation
Consult a qualified expert or Medicare program representative for more details.
What’s Covered?
Medicare allows one pair of extra-depth shoes per calendar year. For qualifying patients, Medicare will also cover three pairs of inserts each calendar year. Some shoe modifications are also covered but would replace a pair of inserts.
Note: Medicare only covers diabetic shoes and inserts if the doctor is enrolled in Medicare. If not enrolled, Medicare won’t pay the claims submitted by them. Doctors and suppliers must meet guidelines to enroll and stay enrolled in Medicare.
Need More Information on Medicare Reimbursem*nt?
We can provide a brochure to take to a Primary Care Physician to see if you’re eligible and get the paperwork started. This pamphlet explains the process for both the patient and doctor with and includes simple instructions and forms the doctor needs to complete. It also has some important facts about diabetes foot health.
To receive this free brochure in the mail, along with one of our catalogs and a list of providers in your area, email your request with your name and address tocatalog@drcomfort.com.
Standard Billing and Reimbursem*nt Disclaimer
DJO Global provides possible coding suggestions based on publicly-available information as a convenience to our customers. DJO Global products that have been assigned HCPCS codes by Medicare through the coding verification process are posted below. The assigned codes are the required billing codes for these particular products. For all other products, it is within the sole discretion of the customer to determine the appropriate billing code, as well as whether the use of a product complies with medical necessity standards and meets all documentation requirements of the payor. DJO Global accepts no responsibility whatsoever in this regard, nor does DJO Global make claims, promises or guarantees as to the availability of reimbursem*nt for any DJO Global product.
