Page 279 - Medicare Benefit Policy Manual

Associated with multiple sclerosis *
Associated with uremia (chronic renal disease) *
Associated with traumatic injury
Associated with leprosy or neurosyphilis
Associated with hereditary disorders
• Hereditary sensory radicular neuropathy
• Angiokeratoma corporis diffusum (Fabry’s)

• Amyloid neuropathy

When the patient’s condition is one of those designated by an asterisk (*), routine
procedures are covered only if the patient is under the active care of a doctor of medicine
or osteopathy who documents the condition.

E. Supportive Devices for Feet

Orthopedic shoes and other supportive devices for the feet generally are not covered.
However, this exclusion does not apply to such a shoe if it is an integral part of a leg
brace, and its expense is included as part of the cost of the brace. Also, this exclusion
does not apply to therapeutic shoes furnished to diabetics.

F. Presumption of Coverage

In evaluating whether the routine services can be reimbursed, a presumption of coverage
may be made where the evidence available discloses certain physical and/or clinical
findings consistent with the diagnosis and indicative of severe peripheral involvement.
For purposes of applying this presumption the following findings are pertinent:

Class A Findings

Nontraumatic amputation of foot or integral skeletal portion thereof.

Class B Findings

Absent posterior tibial pulse;
Advanced trophic changes as: hair growth (decrease or absence) nail changes
(thickening) pigmentary changes (discoloration) skin texture (thin, shiny) skin
color (rubor or redness) (Three required); and
Absent dorsalis pedis pulse.

Class C Findings

Claudication;
Temperature changes (e.g., cold feet);
Edema;