Web2. Prescription for Diabetic Shoes and Inserts SafeStep will create and fax to MD: 3. Physician Notes on Qualifying Condition(s) 4. Statement of Certifying Physician Once signed forms received from Certifying Physician, “WorryFree DME” will create: 5. Certificate of Patient Receipt Once shoes indicated as being dispensed, “WorryFree DME ... WebEligibility for coverage of therapeutic shoes, modifications, and inserts for persons with diabetes under Medicare requires a physician or qualified Non-Physician Practitioner …

Therapeutic Shoes Coverage - Medicare

Webdiabetic condition. 5. The above information is documented in the patient’s medical record, as indicated in the attached clinical notes. Signature (M.D. or D.O.): Date: PA-C’s or ARNP’s are not eligible to sign this form per Medicare Guidelines for Therapeutic Shoes Physician Name: NPI#: Phone: Fax: Diabetic Footwear http://thefittingplace.com/wp-content/uploads/2024/04/medicare-forms-for-diabetic-shoes2.pdf napa county online tax payments

How To Complete Diabetic Shoe Medicare Forms Correctly

WebType of Footwear Covered. If an individual qualifies, they are limited to one of the following footwear categories within one calendar year: 1. One pair of extra-depth shoes and three pairs of ... WebApex diabetic shoes have been in the business of manufacturing and distributing the finest diabetic shoes available anywhere for nearly 50 years. Throughout its history, Apex has designed and constructed its diabetic shoes specifically … WebDiabetic Shoes and Inserts Please provide the above named patient with the following: One pair of therapeutic off-the-shelf depth-inlay shoes (A5500) with three pairs heat molded multi-density inserts (A5512) ☐ One pair of therapeutic off the shelf depth-inlay shoes (A5500 with three pairs custom molded multi-density inserts (A5513) napacounty.org