Page 146 - Medicare Benefit Policy Manual

o Peripheral neuropathy with evidence of callus formation;

o History of pre-ulcerative calluses;

o History of previous ulceration;

o Foot deformity;

o Previous amputation of the foot or part of the foot; or

o Poor circulation.

D. Prescription

Following certification by the physician managing the patient’s systemic diabetic
condition, a podiatrist or other qualified physician who is knowledgeable in the fitting of
diabetic shoes and inserts may prescribe the particular type of footwear necessary.

E. Furnishing Footwear

The footwear must be fitted and furnished by a podiatrist or other qualified individual
such as a pedorthist, an orthotist, or a prosthetist. The certifying physician may not
furnish the diabetic shoes unless the certifying physician is the only qualified individual
in the area. It is left to the discretion of each A/B MAC (B) to determine the meaning of
“in the area.”

150 - Dental Services
(Rev. 11995; Issued: 04-21-23; Effective: 01-01-23; Implementation: 05-12-23)

As indicated under the general exclusions from coverage in 42 CFR 411.15(i), and subject to
exceptions, items and services in connection with the care, treatment, filling, removal, or
replacement of teeth or structures directly supporting the teeth are not covered. “Structures
directly supporting the teeth” means the periodontium, which includes the gingivae,
dentogingival junction, periodontal membrane, cementum of the teeth, and alveolar process. Two
statutory exceptions to this policy allow for Medicare payment for inpatient hospital services in
connection with the provision of dental services if the individual, because of the individual’s