Therapeutic footwear is used to prevent diabetic ulcers. Orthopedic footwear is used by individuals with structural conditions of the foot.
Therapeutic shoes, modifications and inserts must be prescribed by a podiatrist or physician knowledgeable in the fitting of diabetic shoes and inserts.
Orthopedic shoes, modifications and inserts must be prescribed by a podiatrist or physician knowledgeable in the fitting of orthopedic shoes and inserts
All shoes, modifications and inserts must be fitted and furnished by a qualified individual such as a podiatrist, pedorthist, orthotist or prosthetist.
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare in order to assist recipients for whom MHCP is not the primary payer.
MHCP quantity limits and thresholds apply to all recipients unless only Medicare co-insurance or deductible is requested.
Orthotics are covered for all eligible MHCP recipients.
Codes: A5500-A5501 (therapeutic shoes), A5503-A5507 (modifications to therapeutic shoes), A5510-A5513 (inserts for therapeutic shoes)
Custom-made or stock therapeutic shoes and modifications to therapeutic shoes are covered for MHCP recipient with diagnosed diabetes and one or more of the following conditions:
Inserts for therapeutic shoes, whether custom-made or stock, are covered only when the recipient has covered therapeutic shoes.
2 pair of therapeutic shoes, modifications and inserts are covered without authorization in a calendar year. They can be dispensed at the same time, or at different times.
MHCP uses the coding guidelines for therapeutic shoes, modifications and inserts that are found in the Medicare Local Coverage Article for Therapeutic Shoes for Persons with Diabetes for Medicare’s DME MAC contractor for the state of Minnesota.
Codes: L3000-L3031 (custom inserts), L3040-L3060 (premolded, removable arch supports), L3070-L3100 (non-removable arch supports), L3140-L3150 (abduction and rotation bars), L3224-L3253 (orthopedic footwear), L3300 – L3595 (additions and modifications to orthopedic shoes), L3600-L3640 (transfer of orthotic), L3649
MHCP will cover custom-made orthopedic shoes, modifications and inserts when the shoe is an integral part of a leg brace, or for recipients with one or more of the following medical conditions:
MHCP will cover stock orthopedic shoes for recipients only if the shoes are an integral part of a covered leg brace and if they are medically necessary for the proper functioning of the leg brace.
MHCP will cover stock inserts only for use in covered orthopedic shoes.
1 pair of orthopedic shoes and 2 pair of inserts are covered without authorization in a calendar year.
A foot pressure off-loading device is covered for pressure reduction for existing pressure ulcers on the foot.
Authorization for orthopedic footwear is required only when a second or subsequent pair of orthopedic shoes or a third or subsequent pair of inserts is required in any calendar year. Authorization will be granted when the items are needed because of a change in the recipient’s medical condition or size which requires replacement.
Authorization for therapeutic footwear is required only when a 3rd pair or subsequent pair of therapeutic shoes or inserts is required in any calendar year. Authorization will be granted when the items are needed because of a change in the recipient’s medical condition or size which requires replacement
Submit authorization requests through MN-ITS (Authorization Request 278). Fax the MN-ITS response with the required documentation, physician’s orders and appropriate additional information to the medical review agent. Write the MN-ITS Authorization Request number on each page of each document.
Affiliate: A person that directly or indirectly, through one or more intermediaries, controls or is controlled by, or is under common control with, the referring physician or consultant.
Custom-made: Made for a specific patient from his or her individual measurements and/or pattern
Inserts: Artificial devices which are placed in a shoe to assist in restoring or maintaining normal alignment of the foot
Physiatrist: A physician who specializes in physical medicine or who possesses specialized knowledge of rehabilitation and who is certified by the American Board of Physical Medicine and Rehabilitation.
Prosthetic: An artificial device, as defined by Medicare, to replace a missing or nonfunctional body part
Stock: Off the shelf items that are not fabricated to an individual’s specifications. They may be adjusted or altered to meet the recipient’s needs, but are not made specifically for the recipient.Report/Rate this page