MARATHON ORTHOTICS INC.
Custom Medical Foot Orthotics Laboratory
TSB INSTRUCTIONS MEDICARE’S THERAPEUTIC SHOE BILL PROCESS ·To get started you need a Medicare Provider number and must be participant in the Medicare Program. ·You also need to become a DMEPOS (durable medical equipment, prosthetics, orthotics and supplies supplier). You need this number to BILL Medicare for the shoes and inserts. ·If you do not have a DMEPOS number, you can find the application at www.palmettogmb.com or National Supplier Clearinghouse, PO Box 100142, Columbia SC 29202-3142, 866-238-9652. 1.Patient presents with Diabetes and you determine they would be helped by Custom Molded Orthotics: See the Statement of Certifying Physician for the eligibility requirements. Each year, patients who qualify are entitled to receive one pair of “depth” shoes and three pairs of removable shoe inserts. 2.The bill is for BOTH 1 pair of qualifying shoes and 3 pairs of orthotics each year. Medicare may cover the cost of inserts without special shoes if the prescribing (you) doctor verifies that the inserts will be used in shoes that meet the definition for custom molded and depth shoes.
3.You (Supplier) prepare the “Statement of Certifying Physician” and send it to the M.D. or D.O. who manages the patient’s diabetes. They need to certify, sign this form, and return it to you for your files. The ICD-9 code must be included. 4.You (Supplier) complete a prescription form for the diabetic shoes and/or inserts.
5. The footwear must be fitted and furnished by a podiatrist or other qualified individual, such as a Pedorthist, orthotist or prosthetist. The certifying physician may not furnish the footwear unless he or she practices in a rural area or health professional shortage area. The prescribing physician (you) may be the supplier. 6. Make foam impression of the patient’s foot/feet. We can arrange to have the foam impression kits drop shipped to your clinic. Please note that you can bill your Medicare carrier for the patient visit associated with the determination of need and also for the casting supplies(foam). 7. Mail foam impression kit and our prescription form to us using prepaid labels. Include instructions for cut outs and either the shoe size or drawing of insole. 8. Three pairs of Medicare compliant inserts will be mailed to you after 5 business days in our lab, along with an invoice. These inserts meet the Medicare definition: 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. 9. You bill Medicare for reimbursement. Exact reimbursement for your area can be obtained by contacting the National Supplier Clearinghouse at the address and number above. DMERC code number is A5513. 10. Shoe reimbursement is also available from Medicare each year. Again, check with Medicare for exact reimbursement in your area. Additional requirements may apply. Please consult Medicare for more information. This information is a summary of some Medicare rules and is intended for information purposes only. |
