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Diabetic Care |
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Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes is a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. Blood Glucose Monitors
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Diabetes is caused by inadequate levels or reduced effectiveness of insulin. Insulin is responsible for the proper metabolism of blood sugar and the maintenance of blood sugar level. Aside from the immediate effects of elevated blood sugar, the long term effects of diabetes relate to blood vessel changes.
Blood vessel changes often lead to difficulties with the feet. Because of this, people with diabetes are at a greater risk of amputation. With proper footwear, this situation can be greatly reduced.
Click here for information about the Medicare Therapeutic Shoe Bill
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Providers of footwear and foot care have a unique and unparalleled opportunity to help qualified diabetic patients. In an unprecedented move, Congress amended the Medicare statutes to provide partial reimbursement for depth shoes, custom molded shoes, and shoe inserts to qualifying Medicare Part B diabetic patients
Designed to prevent lower limb amputations prevalent in long-term diabetic patients, this new Medicare benefit has the potential to prevent patient suffering, prolong patient life, and save money. According to the CDC, in 1990 there were over 54,000 lower limb amputations due to diabetes. Experts agree that most of these amputations are preventable with appropriate footwear and orthoses
The physician (M.D. or D.O.) who is managing the patient's systemic diabetic condition must certify that:
1. The patient has diabetes mellitus (lCD-9 diagnosis codes 250.00 - 250.91)
2. The patient has one or more of the following conditions:
Previous amputation of the other foot, or part of either foot, or History of previous foot ulceration of either foot, or History of pre-ulcerative calluses of either foot, or Peripheral neuropathy with evidence of callus formation of either foot, or Foot deformity of either foot, or Poor circulation in either foot; and
3. The physician who is managing the patient's systemic diabetes condition has certified that indications I & 2 are met and that he/she is treating the patient under a comprehensive plan of care for his/her diabetes and that the patient needs therapeutic shoes
A qualifying patient is limited to one of the following footwear categories within one calendar year, reimbursed at 80% of the allowable amount:
* One pair of depth shoes and three pair of inserts
-OR-
* One pair of custom molded shoes (including inserts) and two additional pairs of inserts.
Additionally:
1) Separate inserts may be covered under certain criteria
2) A shoe modification will be covered as a substitute for an insert
3) A custom molded shoe is covered when the patient has a foot deformity, which cannot be accommodated by a depth shoe
For a qualified patient to receive this important preventive care,
1. The Certifying Physician (managing the patient's systemic diabetes) must review and sign a Statement of Certifying Physician for Therapeutic Shoes
2. The Prescribing Physician must complete a footwear prescription (see sample form)
Once the patient has the certifying statement and the footwear prescription, he/she can see a pedorthist, orthotist, prosthetist, or podiatrist to have the prescription filled. The supplier will then submit the Medicare claim (Form HCFA 1500) to the appropriate Durable Medical Equipment Regional Carrier (DMERC), keeping copies of the claim form and the original prescription and statement
That's all there is to it!
The Health Care Financing Administration (HCFA) will reimburse at 80% of the allowable amount, either directly to the patient if the supplier does not accept assignment, or to the supplier if the supplier accepts assignment. The patient is responsible for a minimum of 20% of the total payment amount and, perhaps more if the dispenser is not accepting assignment and the dispenser's usual fee is higher than the allowable amount
In 2000, the maximum payment amounts, per pair, are not to exceed the following. Prices may be slightly lower in some areas
Depth Shoes
Total Allowable Amount $126.00 per pair
Amount from HCFA to Patient or Supplier $100.80 per pair
Custom Molded Shoes
Total Allowable Amount $378.00 per pair
Amount from HCFA to Patient or Supplier $302.40 per pair
Inserts or modifications
Total Allowable Amount $64.00 per pair
Amount from HCFA to Patient or Supplier $51.20 per pair
ICD-9 codes
Because this benefit is only available to diabetic patients, an appropriate ICD-9 code (250.00-250.91)
is required when completing the Statement of Certifying Physician

