OAR 410-122-0475: Therapeutic Shoes for Diabetics

(1) Indications and Coverage: (a) For each client, coverage of the footwear and inserts is limited to one of the following within one calendar year: (A) One pair of custom-molded shoes (including inserts provided with such shoes) and two additional pair of inserts; or (B) One pair of extra-depth shoes (not including inserts provided with such shoes) and three pairs of inserts. (b) An individual may substitute modification of custom molded or extra-depth shoes instead of obtaining one pair of inserts, other than the initial pair of inserts. The most common shoe modifications are: (A) Rigid rocker bottoms; (B) Roller bottoms; (C) Metatarsal bars; (D) Wedges; (E) Offset heels. (c) Payment for any expenses for the fitting of such footwear is included in the fee; (d) Payment for the certification of the need for therapeutic shoes and for the prescription of the shoes (by a different practitioner from the one who certifies the need for the shoes) is considered to be included in the visit or consultation in which these services are provided; (e) Following certification by the practitioner managing the client’s systemic diabetic condition, a podiatrist or other qualified practitioner knowledgeable in the fitting of the therapeutic shoes and inserts may prescribe the particular type of footwear necessary. (2) Documentation: (a) The practitioner who is managing the individual’s systemic diabetic condition documents that the client has diabetes and one or more of the following conditions: (A) Previous amputation of the other foot or part of either foot; (B) History of previous foot ulceration of either foot; (C) History of pre-ulcerative calluses of either foot; (D) Peripheral neuropathy with evidence of callus formation of either foot; (E) Foot deformity of either foot; or (F) Poor circulation in either foot; and (G) Certifies that the client is being treated under a comprehensive plan of care for his or her diabetes and that he or she needs therapeutic shoes; (b) Documentation of the above criteria may be completed by the prescribing practitioner or supplier but shall be reviewed for accuracy and signed and dated by the certifying practitioner to indicate agreement and shall be kept on file by the DME supplier. (3) Table 122-0475. [ED. NOTE: Tables referenced are available from the agency.] [ED. NOTE: To view attachments referenced in rule text, click here to view rule.]