Therapeutic Shoes for Diabetics - Who is a Qualified Provider

The therapeutic shoe benefit has the potential to be a limb and life-saving benefit to Medicare beneficiaries with diabetes. However, the benefit can only be gained if the shoes and inserts are constructed and fitted in a proper manner. In addition, care does not end once the product is provided. Because persons with diabetes that qualify for this benefit have insensate feet and/or a history of foot problems, the statute also requires follow-up. The statute also requires that all services must be performed by a qualified individual.

In determining who is a qualified to fit and furnish shoes for diabetics, the Social Security Act section defining the therapeutic shoe benefit states "...the shoes are fitted and furnished by a podiatrist or other qualified individual (such as a pedorthist or orthotist, as established by the Secretary [of the Department of Health and Human Services])." Similarly, the Medicare Carriers Manual (MCM) specifies podiatrists, pedorthists, and orthotists as qualified individuals but also adds prosthetists to this group. To date, there have been no instructions from the Secretary expanding this list.

Podiatrists, as defined by Medicare, are practitioners rendering healthcare services within the scope of their state licensure. Qualified orthotists and prosthetists are practitioners certified by either the American Board of Certification (ABC) or Board of Certification (BOC) in orthotics and/or prosthetics. Qualified pedorthists are practioners certified by the Board for Certification in Pedorthics.

In the absence of instructions from the Secretary expanding the list of qualified individuals, the DMERCs consider podiatrists, pedorthists, orthotists and prosthetists, as defined above, as the only qualified individuals to fit and furnish diabetic shoes under this benefit. Those individuals whose credentials are limited to completion of a manufacturer-sponsored or supplier-sponsored training course are not deemed to be qualified providers. These instructions will be enforced for dates of service on or after January 1, 2003.

Eneslow is proud to have 12 certified pedorthists on staff. Both of Eneslow's locations are accredited BCP facilities.