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 physician 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 physician 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.]

Source: Rule 410-122-0475 — Therapeutic Shoes for Diabetics, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-122-0475.

410–122–0010
Definitions 410–122–0020
Orders 410–122–0040
Prior Authorization 410–122–0080
Conditions of Coverage, Limitations, and Restrictions 410–122–0090
Face-to-Face Encounter Requirements (for Fee-For-Service Clients) 410–122–0180
Healthcare Common Procedure Coding System Level II Coding 410–122–0182
Legend 410–122–0184
Repairs, Servicing, Replacement, Delivery, and Dispensing 410–122–0186
Payment Methodology 410–122–0188
DMEPOS Rebate Agreements 410–122–0200
Pulse Oximeter for Home Use 410–122–0202
Positive Airway Pressure (PAP) Devices for Adult Obstructive Sleep Apnea 410–122–0203
Oxygen and Oxygen Equipment 410–122–0204
Nebulizer 410–122–0205
Respiratory Assist Devices 410–122–0206
Intermittent Positive Pressure Breathing 410–122–0207
Respiratory Supplies 410–122–0208
Suction Pumps 410–122–0209
Tracheostomy Care Supplies 410–122–0210
Ventilators 410–122–0211
Cough Stimulating Device 410–122–0220
Pacemaker Monitor 410–122–0240
Apnea Monitors for Infants 410–122–0250
Breast Pumps 410–122–0260
Home Uterine Monitoring 410–122–0280
Heating/Cooling Accessories 410–122–0300
Light Therapy 410–122–0320
Manual Wheelchair Base 410–122–0325
Power Wheelchair Base 410–122–0330
Power-Operated Vehicle 410–122–0340
Wheelchair Options/Accessories 410–122–0360
Canes and Crutches 410–122–0365
Standing and Positioning Aids 410–122–0375
Walkers 410–122–0380
Hospital Beds 410–122–0400
Pressure Reducing Support Surfaces 410–122–0420
Hospital Bed Accessories 410–122–0475
Therapeutic Shoes for Diabetics 410–122–0510
Osteogenesis Stimulator 410–122–0515
Neuromuscular Electrical Stimulator (NMES) 410–122–0520
Glucose Monitors and Diabetic Supplies 410–122–0525
External Insulin Infusion Pump 410–122–0540
Ostomy Supplies 410–122–0560
Urological Supplies 410–122–0580
Bath Supplies 410–122–0590
Patient Lifts 410–122–0600
Toilet Supplies 410–122–0620
Miscellaneous Supplies 410–122–0625
Surgical Dressing 410–122–0630
Incontinent Supplies 410–122–0640
Eye Prostheses 410–122–0655
External Breast Prostheses 410–122–0658
Gradient Compression Stockings/Sleeves 410–122–0660
Orthotics and Prosthetics 410–122–0662
Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses 410–122–0678
Dynamic Adjustable Extension/Flexion Device 410–122–0680
Facial Prostheses 410–122–0700
Negative Pressure Wound Therapy Pumps 410–122–0720
Pediatric Wheelchairs
Last Updated

Jun. 8, 2021

Rule 410-122-0475’s source at or​.us