Or. Admin. Code § 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.
Notes
Tables referenced are available from the agency.
To view attachments referenced in rule text, click here to view rule.
Statutory/Other Authority: ORS 413.042 & 414.065
Statutes/Other Implemented: ORS 414.065
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.