Skip to Main Content
Issue Number - Name
0141-Therapeutic Shoes and Inserts for Persons with Diabetes
Review Type
Complex
Claim Type
DME by Supplier, DME by Physician
Region and State
JA, JB, JC, JD
Date Approved
02/05/2019

Description

This review will determine if the documentation submitted for review meets Medicare’s coverage requirements for Diabetic Shoes and Inserts. Claims where the documentation submitted does not support the coverage requirements will be denied

Affected Codes

A5500 or A5501 billed with A5512 or A5513

Applicable Policy References

SSA 1861(s)(12)-Definitions of Services, Institutions, Etc., Medical and Other Health Services
SSA 1861(qq)(1)-Definitions of Services, Institutions, Etc., Diabetes Outpatient Self-Management Training Services
SSA 1833(o)-Payment Of Benefits
CMS Pub. 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 140-Therapeutic Shoes for Individuals with Diabetes
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 4, Section 4.26-Supplier Proof of Delivery Documentation Requirements
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.2-Rules Concerning Orders
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.7-Documentation in the Patient's Medical Record
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.8-Supplier Documentation
CMS Pub. 100-08, Medicare Program Integrity Manual, Chapter 5, Section 5.9-Evidence of Medical Necessity
Local Coverage Determination, L33369-Therapeutic Shoes for Persons with Diabetes-Effective 10/1/2015 Revision 10/01/2015, Revision 07/01/2016, Revision 01/01/2017 and Revision 04/01/2018
Local Coverage Article, A52501-Therapeutic Shoes for Persons with Diabetes, Effective 10/1/2015, Revision 10/01/2015, Revision 07/01/2016, Revision 10/01/2016, Revision 01/01/2017 and Revision 04/01/2018
CMS Policy Article, A55426-Standard Documentation Requirements for All Claims Submitted to DME MACS, Effective Date:01/01/2017, Revision 04/20/2017, Revision 05/25/2017, Revision 06/01/2017, Revision 11/20/2017, 12/21/2017, 05/07/2018 and 08/28/18