Medicare Therapeutic Shoe Bill: A Synopsis
By Séamus Kennedy, BEng (Mech), CPed The Medicare Therapeutic Shoe Bill was enacted by Congress in
order to provide proper footwear and inserts for people with
diabetes who qualify under Medicare Part B. The program was
designed to prevent lower limb ulcers, amputations, and other
complications in people who suffer from the disease. Eligible
patients qualify for one pair of shoes, plus extra pairs of inserts
and/or shoe modifications for each calendar year.
 Many of the extra-depth and custom-molded shoe
companies have designed specific programs to meet this bill, which
ensure that the patient gets excellent foot protection and that you
can still make a fair profit. Medicare will reimburse for 80
percent of the amount allowed, and the patient is responsible for a
minimum of 20 percent. The billing codes and allowables for this
program are listed in Table 1.
In order to qualify for the program, certain criteria must be
met. First, the doctoran MD or DOtreating the diabetes must fill
out the "Statement of Certifying Physician" (see Table 2). A copy
of this certificate must be kept in the patient's chart. Second,
you need a prescription for the necessary footwear from the doctor
who is treating the foot condition.
You, as a qualified individual, may then provide the footwear.
As a supplier, you need to have a National Supplier Number in
addition to your Medicare provider number. New paperwork and
prescriptions are required for the replacement of shoes or inserts.
It is also important to note that a "KX" modifier should be used on
your claims to indicate that you have an up-to-date prescription
and Statement of Certifying Physician on file.
This is a general outline of the Therapeutic Shoe Bill. There
are several websites that offer more specific information on the
coding, billing, and shoe choices. Two good examples of sites where
you can obtain more details are: www.safestep.net and www.surefitlab.com Séamus Kennedy, BEng (Mech) CPed, is president and co-owner of Hersco Orthotic Labs, Long Island City, New York. He is a regular speaker on manufacturing and fitting of custom shoes and orthotics. 
Table Of Contents - November 2002
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