Kates Bros, frequently asked questions about custom orthopedic shoes and comfort footwear

In May 1993, congress amended Medicare statutes to provide for partial reimbursement for depth shoes, custom molded shoes, and shoe inserts or modifications to qualifying Medicare Part B patients with diabetes. The Centers for Disease Control has estimated that 82,000 lower limb amputations due to diabetes occur annually (2001-2001) and healthcare experts agree that many amputations are preventable with comprehensive foot care programs, including appropriate footwear that is properly fit.

How You Qualify

The physician (M.D.or D.O.) who manages your systemic diabetic condition is called the certifying physician. The certifying physician must state that you have diabetes mellitus, indicate which one or more of the conditions which Medicare describes as placing you at risk, and state that you are being treated under a comprehensive plan of care of your diabetes and need therapeutic shoes and inserts because of the diabetes.

What is Reimbursable?

Within a given calendar year, the qualifying patient can receive 80% of the allowed amounts for one pair of depth shoes and three pair of inserts OR one pair of custom modeled shoes (which include 1 pair of inserts) and two additional pairs of inserts. Also: 1) shoe modifications can be substituted for an insert; and 2) custom modeled shoes are only covered when you have a foot deformity that cannot be accommodated by a depth shoe. The inserts can be either direct-formed prefabricated inserts that have been heat modeled or custom-modeled inserts that have been individually fabricated for you.

Here is What You Need to do

A certifying physician (M.D. or D.O.) must review and sign a Statement of Certifying Physician for Therapeutic Shoes prior to Kates Bros. dispensing the shoes and inserts. The prescribing physician (who can also be the certifying physician or DPM) must complete a prescription. You can then see a Board Certified Pedorthist to have the prescription filled. For traditional fee for service Medicare patients, Kates Bros. will keep the documentation and submit the claim to Medicare on your behalf.

Patient Payment

The Centers for Medicare and Medicaid Services (CMS) will reimburse up to 80% of the amount it designates as "allowable" and you are responsible for paying Kates Bros. a minimum of 20% of the total payment amount. In some cases the total cost of the goods may be higher than the allowable amount. In such cases you are expected to pay Kates Bros. the full amount and Kates Bros. will then file the appropriate paperwork with Medicare on your behalf for reimbursement directly to you.

What You Can Expect

Kates Bros. offers many different styles of Medicare approved footwear. Kates Bros. will fit you with the proper size and style of footwear that is appropriate for you. Fitting therapeutic footwear to a patient’s foot requires special skills and care. Kates Bros. personnel are trained and skilled in proper fitting techniques. You will be asked to return to Kates Bros for a follow up visit after receiving your shoes in order that we may check the fit and wear.