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Diabetic Footwear Program - Medicare
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Diabetic Footwear Program

For Depth Shoes (5500),   Custom Made  (5513)and Heat Moldable  

Diabetic Inserts (5512)

 

  Call 800-524-2845 
  or send us an e-mail:
  click here

 

 

 

Medicare Information

• Medicare Policies

• Reject Codes

 

 PDAC JURIDICTIOS:

• A   • B   • C   • D
 

Orthofeet customers only
   To order online,
please click here 
 

Orthofeet shoes and orthotics are approved by Medicare to meet

the requirements of 

the Diabetic Shoe Bill
(A5500, A5512 and A5513)

 

The Best Diabetic 
Shoe Program...
Orthofeet shoes and orthotics are approved by Medicare to meet
the requirements of the Diabetic Shoe Bill (codes A5500, A5512 and A5513)

To learn more about The Orthofeet Difference, please click here

- The Highest Quality Footwear

- The Best Diabetic Orthotics

- Attractive Design

- The Lowest Prices

- Slick display -only $150 

- No Restocking Fee

- 100% Satisfaction Guaranteed

Features & Benefits:
•  Supple leather conforms to the contours of the foot, enhancing comfort.
•  Seamless lining, made of soft fabric, and padded with foam, provides excellent protection.
•  The only diabetic prefab orthotic with rearfoot support that offers an arch filler and long lasting support.
•  Cushioning sole, with a true Toe-Spring design, softens the step, and helps propel foot forward.
•  Extra-depth design offers a loose fit and freedom for toe movement.
•  Two removable spacers (1/16” and 1/8” thick) allow the adjustment of the space inside the shoe for a perfect fit.
•  Hidden depth design offers the appearance of regular depth shoes.

 Testimonials:

 

"...Your shoes are fantastic!

No complaints, no problems, and  no  returns since I began prescribing your products for my patients. That adds up to 100% patient satisfaction. It's nice to feel confident with a product which is being used on our highest risk patients.

   Of all the positive attributes to your product, I favor the depth and quality of the shoes. The patients most often say that they love the comfort and looks.

   Keep doing a fine job."

 

                George Varounis, DPM

 ________________________________

 

   "...It's refreshing to find a line of 
 products manufactured with such
 thought for detail in every way. From
 the packaging to the fit, your shoes
 and insoles are superb.
     We started with just a few pair of
 insoles five years ago; our last fill in
 order was for over 200 pair of shoes
 and insoles.
      With confidence I can heartily
 recommend you, your organization
 and your products to anyone
 interested in getting started with the
 ORTHOFEET program.

                         John D. Walker C.Ped.

Facts About The Diabetic Shoe Bill

What Is Covered by Medicare?
Medicare covers 80% of the cost of the following (per year):

  • One pair of  Depth Shoes.
  • 3 pair of inserts.

Billing Codes

A5500 For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe.
 
A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient’s foot, including arch, base layer minimum of Ό inch material of shore a 35 durometer, or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each.
 
A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher, includes arch filler and other shaping material, custom fabricated, each.
 
Toe Filler
L5000 		Partial foot, shoe insert with longitudinal arch, toe filler (Inserts for missing toes or partial foot amputation).
(A5500, A5512 and A5513).(A  

Code Modifiers:
KX Specific required documentation on file
LT Left side
RT Right side
 
Coverage - Diabetic shoes, inserts and/or modifications are covered if the following criteria are met:

1)

 Patients who have diabetes mellitus (ICD-9-CM diagnosis code 250.00-250.91) and:
 

2)

 This patient has one or more of the following conditions:
a. History of partial or complete amputation of the foot.
b. History of previous foot ulceration.
c. History of pre-ulcerative callus.
d. Peripheral Neuropathy with evidence of callus formation.
e. Foot deformity.
f. Poor circulation.
 
3) The certifying physician, who is managing the patient's systemic diabetes condition has certified that indications (1) and (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 diabetic shoes. The certifying physician must be an M.D. or D.O.

This policy requires that the certifying physician, providing the medical care for the diabetic condition must sign a statement that the conditions stated above are met.

The prescribing physician may be a podiatrist, M.D. or D.O. and should write the order for the therapeutic shoes, modifications, and inserts.

The supplier, the person or entity furnishing the shoes, modifications, or inserts may be a podiatrist, pedorthist, orthotist, prosthetist, or other qualified individual. The supplier should bill Medicare for the service.

------------------------------------------------------------------------------

STATEMENT OF CERTIFYING PHYSICIAN

A supplier must have a faxed or original signed statement of certifying physician in their records before submitting a claim to Medicare. A new certification statement is required for a shoe or insert that is provided more then one year from the most recent statement on file. The certifying physician must be an M.D. or D.O.

---------------------------------------------------------------------------------------------------------------

STATEMENT OF CERTIFYING PHYSICIAN

FOR THERAPEUTIC SHOES

PATIENT NAME:______________________________________________________

HIC #:______________________________________________________________

1) The patient has diabetes mellitus.

2) This patient has one or more of the following conditions:

a. History of partial or complete amputation of the foot.

b. History of previous foot ulceration.

c. History of pre-ulcerative callus.

d. Peripheral Neuropathy with evidence of callus formation.

e. Foot deformity.

f. Poor circulation.

3) I am treating this patient under a comprehensive plan of care for his/her diabetes.

4) This patient needs special shoes and or inserts because of his/her diabetes.

 

I certify that all of the preceding circled statements are true.

Physician Signature:___________________ ______________Date:_____________

Physician name :_____________________________________________________

(printed - MUST BE AN M.D. OR D.O.)

Address:____________________________________________________________

___________________________________________________________________

___________________________________________________________________

Physician UPIN:_______________________________________________________

To print the STATEMENT OF CERTIFYING PHYSICIAN click here.

 

Compliance Section:
Note: Some of the files on this page are available only in Adobe Portable Document Format (PDF). PDF files retain the rich formatting of printed documents. To view PDF files, you must have the Adobe Acrobat Reader . If you do not already have the Acrobat Reader installed, please go to Adobe's Acrobat download page now.
Compliance
NPI Application NPI Application/Update Form [PDF, 68KB] - When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.
CMS Medicare DMEPOS Supplier Standards This list is an abbreviated version of the application certification standards, that every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. pt. 424, sec 424.57(c) and are effective on December 11, 2000. A supplier must disclose these standards to all customers/patients who are Medicare beneficiaries (standard 16).
Compliance Notice COMPLAINT RESOLUTION POLICY A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
Complaint Resolution Form The Complaint Resolution Form is used to collect the information about the patient's complaint regarding the DME item, record the resolution to the complaint and ensure the patient is satisfied with the solution. This form, when completed, should go into the Patient's chart. It is also a Medicare requirement that the physician record this information.
Complaint Log The Complaint Resolution Log is used by the patient to log complaints. In conjunction with the Complaint Resolution Form it is used to ensure the resolution to a complaint is completed. This should be kept as a running log to summarize complaints at a glance. It is also a Medicare requirement that the physician record this information.
Blank HIPAA A blank HIPAA Business Associate Agreement.

Break-In instructions for new shoes.

Congratulations on receiving your new shoes. In accordance with Medicare regulations, they have been selected from our own inventory, from another company or have been fabricated to provide you with optimum comfort and protection. In order to receive the greatest benefits from this footwear, please follow these suggested guidelines.

Getting used to your shoes
People with decreased feeling in their feet may have a false sense of security as to how much at risk their feet actually are. An ulcer under the foot can develop in a couple of hours even if the shoes are expertly fit. In order to best avoid any irritation, please adhere to the following break-in schedule:

FIRST DAY

Wear One Hour

SECOND DAY

Wear Two Hours – Check feet after first hour

THIRD DAY

Wear Three Hours

FOURTH DAY

Wear Four Hours – Check feet after two hours

FIFTH DAY

Wear Full Day – Check after lunch
  • IF AT ANY TIME YOU SEE RED SPOTS OR DARKNESS ON THE TOES OR OTHER BONY AREAS DURING THE FIRST FIVE DAYS: Discontinue wearing the shoes for the rest of the day and start routine again the next day beginning with one hour of wear.
  • IF A RED SPOT OR DARKNESS APPEARS WITH EVERY WEARING – DO NOT WEAR SHOES. Call our office for an adjustment appointment.
  • BE SURE TO INSPECT YOUR FEET EVERY DAY.

Follow-Up
You should have regularly scheduled visits with our office. Please direct any questions about the items received today to this office. Billing questions may be directed to your Medicare carrier. Every four months get rid of the inserts in your shoes and put in a new pair. In one year, you will receive a reminder to return to our office to evaluate the condition of these shoes.

Return Policy
Shoes that are unsuitable may be returned within four weeks of dispensing. The shoes must be in good condition, i.e., no scuffmarks, outside dirt or obvious wear on the soles. We strongly urge you to wear these shoes in your home for the first week. Substandard shoes may also be returned as all warranties, expressed and implied under applicable State law will be honored.

I certify that I have received the item(s) marked below in good condition. The Practitioner has explained, in detail, the proper use and care of this device and has fit it to me. The Practitioner has asked me to call the office if I encounter any problems with the device or if I have any questions. I have been informed of the Medicare DMEPOS Supplier Standards.

Name:_______________   Signature:_______________________

Date___________

Qty:____  Manufacturer:____________  Description:___________________________________

Size:_____Width:_____

Qty:____  Manufacturer:____________  Description:___________________________________

Size:_____Width:_____
     
Original: To Patient      Copy: To Patient File      Faxed Date:______________________

To print the Break-In instructions, please click here.

 

26 Supplier Standards

Resource: Medicare Enrollment Application, DMEPOS, Form CMS-855S, http://www.cms.hhs.gov/cmsforms/downloads/cms855s.pdf [PDF]

Note: This list is an abbreviated version of the application certification standards that every Medicare DMEPOS supplier must meet in order to obtain and retain their billing privileges. These standards, in their entirety, are listed in 42 C.F.R. pt. 424, sec 424.57(c) and were effective on December 11, 2000.

  1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
  2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
  3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.
  4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or nonprocurement programs.
  5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
  6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare-covered items that are under warranty.
  7. A supplier must maintain a physical facility on an appropriate site.
  8. A supplier must permit CMS or its agents to conduct on-site inspections to ascertain the supplier's compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.
  9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine, or cell phone is prohibited.
  10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier's place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations. Failure to maintain required insurance at all times will result in revocation of the supplier's billing privileges retroactive to the date the insurance lapsed.
  11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from calling beneficiaries in order to solicit new business.
  12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare-covered items, and maintain proof of delivery.
  13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
  14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
  15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
  16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.
  17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
  18. A supplier must not convey or reassign a supplier number; i.e. the supplier may not sell or allow another entity to use its Medicare Supplier Billing Number.
  19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
  20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
  21. A supplier must agree to furnish CMS any information required by the Medicare statute and implementing regulations.
  22. All suppliers must be accredited by a CMS-approved accreditation organization in order to receive and retain a supplier billing number. The accreditation must indicate the specific products and services, for which the supplier is accredited in order for the supplier to receive payment of those specific products and services (except for certain exempt pharmaceuticals).
  23. All suppliers must notify their accreditation organization when a new DMEPOS location is opened.
  24. All supplier locations, whether owned or subcontracted, must meet the DMEPOS quality standards and be separately accredited in order to bill Medicare.
  25. All suppliers must disclose upon enrollment all products and services, including the addition of new product lines for which they are seeking accreditation
  26. Must meet the surety bond requirements specified in 42 C.F.R. 424.57(c). Implementation date- May 4, 2009

To print the CMS MEDICARE DMEPOS SUPPLIER STANDARDS, please click here.

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