Custom diabetic shoes for amputee- Responses
Randy McFarland
Description
Collection
Title:
Custom diabetic shoes for amputee- Responses
Creator:
Randy McFarland
Date:
1/13/2012
Text:
ORIGINAL POST
I understand that Medicare will pay for a pair of non-custom diabetic shoes
(not inserts) for a diabetic LE amputee with a prosthesis. Will Medicare do
the same for custom shoes? We recently had this case and we sent a tracing
of the prosthetic foot and told the manufacturer the prosthetic foot size
and we were paid. Is this your experience?
If the custom shoe wasn't paid by insurance, do you still have a custom shoe
made so it will match the sound foot custom shoe and have the patient pay
for it? Do you ask the manufacturer to try to make the custom shoe match a
prefab. shoe model so they'll match? I'll post responses. Thanks, Randy
McFarland, CPO
RESPONSES
They will typically cover a custom shoe for just the anatomical foot. They
won't cover the custom shoe code for a prosthetic foot. Comes back to
justification. Why do you need a custom shoe for a prosthetic foot?
I actually casted the prosthetic foot and sent it along requesting they
match the other shoe. Looks fine. Not sure about coverage.
Medicare will not pay for a shoe if the person is wearing a B/K or A/K
Prosthesis. If he has a partial foot they will pay for that. You may get
paid for a pair of shoes, but it will get charged back to you
eventually.That is why shoes are billed (Lt & Rt) and not as a pair.
We use Apis Shoes. They will make any of their stock shoes as customs shoes
from a cast and provide the other shoe from stock. We have billed for the
custom shoe and one stock shoe for prosthetic side.
I think if your amputee is unilaterally involved then I would want a regular
shoe that to fits your prosthetic foot. If your patients intact foot is
grossly wide then the prosthetic side will visually not match. If your
patient wants their shoes to match cosmetically I think Medicare or Medicaid
would definitely see the problem to be cosmetic. I would let the patient
know they would have to pay privately for a matched pair, and that you would
bill as a courtesy.
I understand that Medicare will pay for a pair of non-custom diabetic shoes
(not inserts) for a diabetic LE amputee with a prosthesis. Will Medicare do
the same for custom shoes? We recently had this case and we sent a tracing
of the prosthetic foot and told the manufacturer the prosthetic foot size
and we were paid. Is this your experience?
If the custom shoe wasn't paid by insurance, do you still have a custom shoe
made so it will match the sound foot custom shoe and have the patient pay
for it? Do you ask the manufacturer to try to make the custom shoe match a
prefab. shoe model so they'll match? I'll post responses. Thanks, Randy
McFarland, CPO
RESPONSES
They will typically cover a custom shoe for just the anatomical foot. They
won't cover the custom shoe code for a prosthetic foot. Comes back to
justification. Why do you need a custom shoe for a prosthetic foot?
I actually casted the prosthetic foot and sent it along requesting they
match the other shoe. Looks fine. Not sure about coverage.
Medicare will not pay for a shoe if the person is wearing a B/K or A/K
Prosthesis. If he has a partial foot they will pay for that. You may get
paid for a pair of shoes, but it will get charged back to you
eventually.That is why shoes are billed (Lt & Rt) and not as a pair.
We use Apis Shoes. They will make any of their stock shoes as customs shoes
from a cast and provide the other shoe from stock. We have billed for the
custom shoe and one stock shoe for prosthetic side.
I think if your amputee is unilaterally involved then I would want a regular
shoe that to fits your prosthetic foot. If your patients intact foot is
grossly wide then the prosthetic side will visually not match. If your
patient wants their shoes to match cosmetically I think Medicare or Medicaid
would definitely see the problem to be cosmetic. I would let the patient
know they would have to pay privately for a matched pair, and that you would
bill as a courtesy.
Citation
Randy McFarland, “Custom diabetic shoes for amputee- Responses,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/233250.
