For Physicians

As you all know, Medicare and other insurances are enforcing stricter rules and regulations. As partners in caring for your patients, we will not receive payment for the items that are ordered if you do not provide detailed information in your medical records for such items. We are here to help you with this process for our mutual patients.

Prosthetic Patients are at the top of the list with the new guidelines for their referring physicians. I have attached a few links of information that can help you in completely your notes as well as explaining the guidelines further.

Medicare Physician Letter
Documentation Guide for Physicians

 

Diabetic Shoes and Inserts are near the top of the list as well for physician documentation. It must be stated in your records that Diabetic shoes and inserts (custom molded or off the shelf) are needed to provide stabilization for the ambulator. If the patient has ulcers, bunions, toe amputation(s), neuropathy, etc. this also needs to be listed in your physician records. Some commercial plans (BCBS, Cigna, UHC, etc). will not cover diabetic shoes. Medicare, Medicare Replacement Plans, and Medicaid will cover diabetic shoes and inserts if the criteria is met. I have attached a few links of the required paperwork for these insurance plans.

Diabetic Shoes Packet (Medicare & Medicare Replacement Plans)
Medicaid Only Patients;Form for Diabetic Shoes IN ADDITION to Packet Above

 

For all other orthotics, it must be documented in your physician notes on why a custom built device is needed over an off the shelf device. A orthotist or prosthetist may be able to help you in determining this factor once our consultation has been performed. If you would like more information on our Local Coverage Determination ruling, please see the following link to Medicare’s website.

https://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=140&ContrVer=2&CntrctrSelected=140*2&name=CGS+Administrators%2c+LLC+(18003%2c+DME+MAC)&LCntrctr=140*2&bc=AgACAAAAAAAA&