WebEligibility for coverage of therapeutic shoes, modifications, and inserts for persons with diabetes under Medicare requires a physician or qualified Non-Physician Practitioner … Web1. Take the enclosed Diabetic Footwear Prescription Form (Page 2 in PDF Link Below) to either your M.D., D.O., Endocrinologist or Podiatrist to complete. The prescription must be specific as to the type of footwear and inserts you require. Please remember this prescription is only valid for 90 days from the date it is signed.

Medicare Forms for Diabetic Shoes - The Fitting Place

WebDec 9, 2024 · The certification statement must be completed on or after the date of the in-person visit and within three months prior to delivery of the diabetic shoes by the … WebTo obtain a prescription, print out the form that is right for you and take it to your health care professional. Compression Stocking Prescription Diabetic Shoes & Inserts … gaffirs new years day swim

Health Forms Foot Health Professionals in Lakewood …

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 ... WebMedicare provides coverage for extra-depth shoes, custom-molded shoes, and shoe inserts for people with diabetes who qualify under Medicare Part B. WebTo qualify as a diabetic shoe, certain standards must be met: Protective, soft interior without protruding stitches Non-binding, stretchable uppers conform to the foot and prevent pressure points Extra depth provides a pressure-free fit that can accommodate thick orthotic inserts Deep toe box allows toes to move freely and not press on each other gaffiot texte