Diabetes is reaching epidemic proportions in the United States. During the past decade, there has been an increase of 33% with the diabetic population currently topping 16 million people. There are many complications associated with diabetes including kidney, heart, vision, circulatory and foot problems. The good news is that many of these potential problems can be minimized as a result of life style changes, medications and other preventive care.

Amputations, or partial amputations, of the feet and legs are also growing at an alarming rate. In fact, it is the leading cause of non-traumatic amputation in the United States. Recently a task force was created by officials from Medicare, the American Podiatric Medical Association and the American Diabetes Association in order to explore ways to reduce the number of amputations in the diabetic populations. The number of these lower extremity amputations grew by 28% in just the past several years. However, it has been determined that over half of these amputations could have been prevented by timely conservative foot care.

At Capital Foot & Ankle Centers, we are authorized Medicare Suppliers to evaluate, prescribe and dispense high quality, extra-depth shoes and 3 pairs of removable protective shoe inserts per calendar year. Many diabetic patients qualify for this benefit and Medicare will pay 80% of the cost for the shoes and insoles and your supplemental insurance may pay the other 20%.

Medicare established the Diabetic footwear benefit to lower the incidence of diabetic foot complications such as ulceration and amputation in the diabetic population. Due to the preventive nature of this program, a patient may qualify for shoes and inserts without a history of any foot complications.

To qualify for the benefit, the following criteria must be met:

1. The patient has type I or type II diabetes mellitus (diagnosis codes 250.00-250.93) either insulin dependent or dietary controlled.

2. The patient has one or more of the following conditions:

a) Previous amputation of the other foot, or part of either foot.
b) History of previous foot ulceration of either foot.
c) History of pre-ulcerative calluses of either foot.
d) Peripheral neuropathy with evidence of callus formation of either foot.
e) Foot deformity of either foot, such as bunions, hammertoes, flat feet, etc. (At this time Medicare has not stated what type of foot deformity needs to be present. However, you may infer that it would be a deformity that could cause a problem if the patient was not wearing a properly fitted shoe and molded insert.)
f) Poor circulation in either foot.

3. The certifying physician who is managing the patient's systemic diabetes condition has certified that:

a) The indications listed in (1) and (2) are present.
b) The physician is treating the patient under a comprehensive plan of care for his/her diabetes.
c) The patient needs diabetic shoes.

The above information for each patient is documented on the Statement of Certifying Physician Form. The certifying physician (M.D. or D.O.) in completing the form certifies medical necessity for the service. This statement may be completed by the prescribing physician or supplier (podiatrist) but must be reviewed for accuracy and signed by the certifying physician (M.D. or D.O.) to indicate agreement.

As authorized Medicare suppliers, the doctors at Capital Foot & Ankle Centers are qualified to evaluate, prescribe and dispense these protective products to patients.