Diabetic Shoes

A depth shoe (A5500) must meet the following definition to qualify for the benefit category:

1. Has a full length, heel-to-toe filler that when removed provides a minimum of 3/16" of additional depth used to accommodate custom-molded or customized inserts.
2. Is made from leather or other suitable material of equal quality.
3. Has some form of shoe closure.
4. Is available in full and half sizes with a minimum of three widths so that the sole is graded to the size and width of the upper portions of the shoe according to the American standard last sizing schedule or its equivalent.  (The American last sizing schedule is the numerical shoe sizing system used for shoes in the United States.) This includes a shoe with or without an internally seamless toe.

A custom-molded shoe (A5501) must meet the following definition to qualify for the benefit category:

1. Is constructed over a positive model of the patient's foot.
2. Is made from leather or other suitable material of equal quality.
3. Has removable inserts that can be altered or replaced as the patient's condition warrants.
4. Has some form of shoe closure. This includes a shoe with or without an internally seamless toe.

A custom molded shoe (A5501) is covered when the patient has a foot deformity, which cannot be accommodated by a depth shoe. The nature and severity of the deformity must be well documented in the supplier's records and may be requested by the DMERC. If there is insufficient justification for a custom molded shoe, but the general coverage criteria are met, payment will be based on the allowance for the least costly medically appropriate alternative, A5500.