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Documentation Reminder—Therapeutic Shoes

The CMS Supplier Standards (42 CFR 424.57) require that suppliers of therapeutic shoes for persons with diabetes are required to perform an in-person visit with the beneficiary for the purpose of determining fit. Recently questions have arisen about the documentation of this in-person visit.

Claim denials by NGS Medical Review staff have resulted from failure of the supplier to document the fitting of the shoes. In many cases, these claims have an attestation from the beneficiary about the quality of the shoe and/or insert fit; however, there is no objective assessment from the supplier of the shoes regarding fit. This objective assessment by the supplier is a critical component of the delivery process.

Medicare and the DME MACs view the supplier of the shoe as a skilled professional with training in the proper assessment of fit and the relationship of the shoe and/or insert to correction of the underlying foot condition. Reliance solely on a beneficiary’s statement about fit and comfort as documentation that the supplier performed an in-person fitting and assessment is inappropriate and will result in claim denials. Subjective statements from the beneficiary are only one component of fit assessment; the supplier must make an independent, objective assessment of the fit as well. Both components must be documented to meet the Medicare policy requirements.

Documentation Reminder—Therapeutic Shoes
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