diabetic footwear, surefit

Medicare policy requires that an insert must be molded to the foot or a
model of the foot to achieve total contact. Medicare states, “Total contact
means it makes and retains actual and continuous physical contact with
the weight-bearing portions of the foot, including the arch throughout the
standing and walking phases of gait”. The podiatrist is responsible for
providing the patient with a total contact device by either heat molding
a prefabricated insert directly to the patient’s foot or ordering a lab
fabricated custom molded insert. As the prescribing physician, the
podiatrist must analyze the patient’s foot structure to determine whether
total contact can be achieved with a prefabricated device or whether a
lab fabricated device is required. The result of this analysis is reported to
Medicare when the inserts are billed with either a A5512 Code for Prefabs
or a A5513 code for custom fabricated inserts. Medicare established these
new codes in April of 2004, which enables the tracking of this data.

Physician as Supplier
The physician should become familiar with the Medicare requirements
for diabetic inserts. They should not rely on claims made by insert
manufacturers that their devices are approved. The physician, who
submits the claim for diabetic inserts, and not the insert manufacturer,
is responsible for demonstrating coverage under the Medicare benefit.
Coverage depends on the physician achieving and documenting
Medicare's requirement of total contact. Medicare instructs physicians
to “consult their DMEPOS Supplier Manual and other quarterly
publications from the DMERC’s in order to bill products in accordance with
DMERC Medical policy.”

Medicare has notified manufacturers/vendors of inserts that they do not
have a liability in terms of payment recoupment. The supplier (podiatrist)
is totally responsible for the decision to bill a covered or non-covered
service and for any Medicare payment recoupment.

There are also specific criteria for benefit coverage of depth shoes.
See the medical policy section for details.