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Medicare diabetic shoe coverage

mcarter1017

Contributor
Messages
14
Best answers
0
Does anyone know if Medicare will cover shoes for a non-ambulatory, paraplegic, diabetic???
 

erjones147

Expert
Messages
385
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0
Coming from a clinic setting, I have never gotten my MAC (Novitas) to pay for any of that stuff
 

Trudy

New
Messages
3
Location
Lafayette, LA
Best answers
0
3. Supportive Devices for Feet
Generally, Medicare will not cover orthopedic shoes and other supportive devices for the
feet, unless it is an integral part of a leg brace and its expense is included as part of
the cost of the brace. Also, a narrow exception permits coverage of therapeutic
shoes and inserts for certain patients with diabetes<<<<<<from CMS.gov. I pray this helps...
 

tammster

Guru
Messages
138
Best answers
0
The LCDCs don't seem to specify that the patient must be amubulatory ... but I did find this blurb in a coverage article (for DME MAC C):


NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements. Information provided in this policy article relates to determinations other than those based on Social Security Act ?1862(a)(1)(A) provisions (i.e. ?reasonable and necessary?).
 
Messages
2
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0
Diabetics, yes!! there are guideline that are required. They must have been seen by their PCP for diabetic care with in 6 months and be currently under their for diabetes. Also there is the need for the RT LT and KX modifiers. Other then that our claims have been getting paid.
 

gnp001

Networker
Messages
47
Location
Maryville, TN
Best answers
0
where to file diabetic shoe claims

I'm new to billing for podiatry and originally I filed the shoes to the Region DMERC and they were denied, so I sent them to regular Medicare or Railroad Medicare. Now I've got a denial from Railroad Medicare saying they are not the correct payor for this service. I'm billing A5500 KX LT and then the same but RT on separate line items. I hope someone out there can help with this! Thanks so much!
 

gnp001

Networker
Messages
47
Location
Maryville, TN
Best answers
0
Melissa, Do the diabetic shoe claims go to the DME Medicare carrier? If so I'll have to call and find out why they are not paying mine. I'm billing A5500 KX LT and A5500 KX RT, does it matter which modifier is first? Thanks so much!
 
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