Web1. This patient has diabetes mellitus. 2. This patient has one or more of the following conditions. (Circle all that apply): a) History of partial or complete amputation of the foot b) History of previous foot ulceration c) History of pre-ulcerative callus d) Peripheral neuropathy with evidence of callus formation e) Foot deformity f) Poor ... Webo Dispensing requirements for: § Bedside commodes § Braces/supports § Canes § Compression or TED hose § Crutches § Diabetic shoes and inserts § Diabetic testing supplies (strips, lancets, monitor, control solution, batteries) § Lymphedema sleeves § Nebulizers and nebulizer solution § Ostomy supplies § Post-op boots § Urological supplies
DOCUMENTATION OVERVIEW - Diabetic Shoes
WebWhen returning these signed forms, make sure that the last diabetic exam is within six months of when the patient can receive the shoes. For example, if the last diabetic … WebFor therapeutic shoes, the detailed written order must include: Beneficiary name. Description of the items provided. Narrative description (e.g., diabetic shoes, custom inserts, etc.) or the specific manufacturer and product name umber of the shoe/insert If a custom item is provided, the order must state "custom fabricated.”. biometric home test kit
Clinicians! Are You Ordering Diabetic Shoes for Your …
WebDiabetic Shoe Forms; Order Forms; Contact; 866.366.8929; Show Search; Search this website. Hide Search. Diabetic Shoe Forms. Podiatric Packet for Shoes & Inserts. Primary/Managing Physician Packet for Shoes and Inserts. Patient Foot Evaluation Form. Detailed Written Order. ... Medicare Supplier Standards . WebOct 27, 2024 · Social Security Act (SSA) section (§)1861 (s) (12) describes coverage for, "extra-depth shoes with inserts or custom molded shoes with inserts for an individual with diabetes" when certain specified requirements are met. Reimbursement is available for shoes used by beneficiaries with diabetes when the applicable coverage requirements … http://thefittingplace.com/wp-content/uploads/2024/04/medicare-forms-for-diabetic-shoes2.pdf daily soccer predictions app