The Therapeutic Shoe Bill (TSB) is designed for the Diabetic patient to receive annually Medicare reimbursement for one pair of adjustable depth shoes, and three pair of multi-density inserts. Both the Advance footwear and the Advance Diabetic insoles qualify under the provisions of the TSB.

The Therapeutic Shoe Bill, Medicare (Part B) provides coverage for adjustable depth-inlay shoes, custom-molded shoes, and shoe inserts for people with diabetes who qualify under Medicare Part B. Protective footwear, such as Advance Orthopedic Footwear, may help prevent lower-limb ulcers and amputations in people who have diabetes, and may prevent suffering and save money. Many diabetes patients are unaware of the benefits available to them under the Therapeutic Shoe Bill, and should be informed of these valuable reimbursements.

If an individual qualifies, he/she is limited to one of the following footwear categories within one calendar year:

1. One pair of depth-inlay shoes and three pairs of inserts. Shoe modification is
covered as a substitute for an insert.
2. One pair of custom-molded shoes (including inserts) and two additional pairs of inserts. A custom-molded shoe is covered when the individual has a foot deformity that cannot be accommodated by a depth shoe.

How Individuals Qualify

The M. D. or D. O. who is treating the patient for diabetes must certify that the individual:

1. Has diabetes.
2. Has one of more of the following conditions:

• History of partial or complete foot amputation
  
• History of previous foot ulceration
  
• History of pre-ulcerative callus
• Peripheral neuropathy with evidence of callus formation
• Poor circulation
• Foot deformity

3. Is being treated under a comprehensive diabetes care plan and needs therapeutic shoes and/or inserts because of diabetes.

Types of Footwear Covered

If an individual qualifies, he/she is limited to one of the following footwear categories within one calendar year:

1. One pair of adjustable depth-inlay shoes and three pairs of inserts
2. One pair of custom-molded shoes (including inserts) and two additional pair of inserts.
3. Separate inserts may be covered under certain criteria. Shoe modification is covered as a substitute for an insert, and a custom-molded shoe is covered when the individual has a foot deformity that cannot be accommodated by a depth shoe.

What the Patient Does to Begin the Process

The Diabetic patient must consult with his/her certifying physician to have the M. D. or D. O. who oversees their treatment review and sign a "Certification Statement for Therapeutic Footwear". This simple form answers basic questions about the Diabetic Foot condition of the patient, and the Comprehensive Care Plan.

The prescribing physician (the D. P. M., orthopedic foot surgeon, or M. D.) must complete a "Prescription Form for Therapeutic Footwear". Once the patient has the signed statement and the prescription, he/she can see a Podiatrist, Orthotist, Prosthetist, or Pedorthist to have the prescription filled. The supplier will then submit the Medicare claim form to the appropriate carrier for reimbursement. Payment for therapeutic shoes is the same as for other Medicare benefits – 80% of the reasonable and allowed Medicare fees. These fees are adjusted every year. Your Medicare insurance carrier will be able to give you a current payment schedule.

Adjustable Depth Shoe: Medicare HCPCS Code = A5500

An adjustable depth shoe is one that 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, such as laces or Velcro and 4) is available in full and half sizes with a minimum of three widths to assure a proper fit. Advance Orthopedic and Comfort Footwear qualifies for reimbursement under this definition.

Custom-Molded Shoe: Medicare HCPCS Code = A5501

A custom-molded shoe is one that 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 and 4) has some form of shoe closure, such as laces or Velcro. Advance Orthopedic Footwear does not qualify under this definition.

Insert: Medicare HCPCS Code = A5512, A5511 and A5513

A5512 (replaces KO628) – For Diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees F or higher, total contact with patient’s foot, including arch, base layer minimum of 3/16 " material of Shore A 40 durometer(or higher), prefabricated. SoleTech’s Advance Diabetic Insole qualifies under this definition

A5510 – For Diabetics only, direct formed, compression molded to patient’s foot without external heat source, multiple density insert(s) prefabricated, per shoe. Will not be reimbursed by Medicare.

A5513 (replaces K0629)– For Diabetics only, multiple density insert, custom molded from model of patient’s foot, total contact with patient’s foot, including arch, base layer minimum of 3/16" material of Shore A 35 durometer or higher, includes arch filler and other shaping material, custom fabricated.