Page 145 - Medicare Benefit Policy Manual

• Metatarsal Bars - An exterior bar is placed behind the metatarsal heads in
order to remove pressure from the metatarsal heads. The bars are of various
shapes, heights, and construction depending on the exact purpose;

• Wedges (Posting) - Wedges are either of hind foot, fore foot, or both and may
be in the middle or to the side. The function is to shift or transfer weight
bearing upon standing or during ambulation to the opposite side for added
support, stabilization, equalized weight distribution, or balance; and

• Offset Heels - This is a heel flanged at its base either in the middle, to the
side, or a combination, that is then extended upward to the shoe in order to
stabilize extreme positions of the hind foot.

Other modifications to diabetic shoes include, but are not limited to flared heels,
Velcro closures, and inserts for missing toes.

4. Separate Inserts

Inserts may be covered and dispensed independently of diabetic shoes if the supplier
of the shoes verifies in writing that the patient has appropriate footwear into which
the insert can be placed. This footwear must meet the definitions found above for
depth shoes and custom-molded shoes.

C. Certification

The need for diabetic shoes must be certified by a physician who is a doctor of medicine
or a doctor of osteopathy and who is responsible for diagnosing and treating the patient’s
diabetic systemic condition through a comprehensive plan of care. This managing
physician must:

• Document in the patient’s medical record that the patient has diabetes;

• Certify that the patient is being treated under a comprehensive plan of care for
diabetes, and that the patient needs diabetic shoes; and

• Document in the patient’s record that the patient has one or more of the following
conditions: