Included with this letter is the Statement of Necessity that is needed for your patients to get diabetic shoes.
Patient Information Needed:
Please ensure the patient's full name, date of birth, contact information, and primary insurance details are attached or written clearly on the paperwork.
Per Medicare, we also need the Chart Notes (progress notes) from the last visit with your patient. Please ensure the notes include the following requirements:
- 1. A formal diabetes diagnosis.
- 2. Documented evidence of a foot exam.
- 3. The specific prescription listed below:
Required In The Chart Notes:
"Rx for diabetic shoes custom diabetic insoles"
*Medicare will not reimburse for shoes or inserts unless a statement mirroring the Rx in the Statement of Necessity is present in the clinical record.*
Please fax the Statement of Necessity, Patient Demographics, Insurance Info, and Exam Notes to: (408) 376-0498.
Thank you,Walk Rite for Life!
Certified Pedorthists (CPed)