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Program & Orthotics
How to complete Medicare’s Therapeutic Shoe Bill Process.
To get started you need a Medicare Provider number. You must also be a participant in the Medicare Program.
You 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 here.
If your 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 pair of removable shoe inserts.
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 physician verifies that the inserts will be used in shoes that meet the definition for custom molded and depth shoes.
Step By Step Instructions
You (Supplier) must prepare the Statement of Certifying Physician and send it to the M.D. or D.O. who manages the patient’s diabetes. They must certify, sign the form, and return it to you for your files. The ICD-9 code must be included.
You (Supplier) complete a Marathon Orthotics, Inc. prescription form for the diabetic shoes and/or inserts.
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.
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).
Next, mail the foam impression kit and our prescription order form to Marathon Orthotics, Inc. using the prepaid labels we supply free of charge. Learn More
Please include instructions for cut-outs and either the shoe size or a drawing of the shoe insole.
The three pairs of Medicare compliant inserts will be mailed to you after 5 business days in our lab, along with an invoice.
Our Inserts are Medicare Complaint
Our 3-pair inserts meet the following 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 of higher, included arch filler and other shaping material, custom fabricated”
You bill Medicare for the reimbursement. Exact reimbursement for your area can be obtained by visiting www.cms.gov. DMERC code number is A5513.
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.