Page 143 - Medicare Benefit Policy Manual

• Have removable inserts that can be altered or replaced as the patient’s
condition warrants; and

• Have some form of shoe closure.

2. Depth Shoes

Depth shoes are shoes that:

• Have a full length, heel-to-toe filler that, when removed, provides a minimum
of 3/16 inch of additional depth used to accommodate custom-molded or
customized inserts;

• Are made from leather or other suitable material of equal quality;

• Have some form of shoe closure; and

• Are available in full and half sizes with a minimum of three widths so that the
sole is graded to the size and width of the upper portions of the shoes
according to the American standard last sizing schedule or its equivalent. (The
American standard last sizing schedule is the numerical shoe sizing system
used for shoes sold in the United States.)

3. Inserts

Inserts are total contact, multiple density, removable inlays that are directly molded to
the patient’s foot or a model of the patient’s foot or directly carved from a patient-
specific, rectified electronic model and that are made of a suitable material with
regard to the patient’s condition.

B. Coverage

1. Limitations

For each individual, coverage of the footwear and inserts is limited to one of the
following within one calendar year: