Page 144 - Medicare Benefit Policy Manual

• No more than one pair of custom-molded shoes (including inserts provided
with such shoes) and two additional pairs of inserts; or

• No more than one pair of depth shoes and three pairs of inserts (not including
the noncustomized removable inserts provided with such shoes).

2. Coverage of Diabetic Shoes and Brace

Orthopedic shoes, as stated in the Medicare Claims Processing Manual, Chapter 20,
“Durable Medical Equipment, Surgical Dressings and Casts, Orthotics and Artificial
Limbs, and Prosthetic Devices,” generally are not covered. This exclusion does not
apply to orthopedic shoes that are an integral part of a leg brace. In situations in
which an individual qualifies for both diabetic shoes and a leg brace, these items are
covered separately. Thus, the diabetic shoes may be covered if the requirements for
this section are met, while the brace may be covered if the requirements of §130 are
met.

3. Substitution of Modifications for Inserts

An individual may substitute modification(s) of custom-molded or depth shoes
instead of obtaining a pair(s) of inserts in any combination. Payment for the
modification(s) may not exceed the limit set for the inserts for which the individual is
entitled. The following is a list of the most common shoe modifications available, but
it is not meant as an exhaustive list of the modifications available for diabetic shoes:

• Rigid Rocker Bottoms - These are exterior elevations with apex positions for
51 percent to 75 percent distance measured from the back end of the heel.
The apex is a narrowed or pointed end of an anatomical structure. The apex
must be positioned behind the metatarsal heads and tapered off sharply to the
front tip of the sole. Apex height helps to eliminate pressure at the metatarsal
heads. Rigidity is ensured by the steel in the shoe. The heel of the shoe tapers
off in the back in order to cause the heel to strike in the middle of the heel;

• Roller Bottoms (Sole or Bar) - These are the same as rocker bottoms, but the
heel is tapered from the apex to the front tip of the sole;