Toe Filler

There is an old yiddish expression that comes to mind here, which translates, "You can't dance at two weddings with one backside at the same time".

Hence you cannot bill for both diabetic shoe inserts and toe fillers at the same time.

Hence in this case you can bill for one pair of shoes and 2 toe fillers (one for the left and one for the right) or you can bill for the six inserts (3 per foot). But not both.

I would argue that if the patient can be fit appropriately with the inserts, then what is the medical necessity for the L5000?

It is important to note that the toe fillers are NOT covered under the therapeutic shoe program but are covered under the lower limb prosthesis LCD.

Hence providing the L5000 toe fillers DO NOT require the arduous paper work of the Therapeutic Shoe LCD.

Toe fillers do not require anything from the PCP or physician managing the DM.

However, for providing the shoes, you will still need all the absurd requirements mandated in the Therapeutic Shoe LCD.

So what does this mean?

One pair of shoes as per the Therapeutic Shoe LCD.

One toe filler for each shoe, which can be replaced as medically necessary.

If it wore out, it can be replaced, there is no same or similar, no 5 year or one year look back, etc.

If the patient had recently had the TMA and recived shoe inserts in the past, they are now being replaced by medically necessary prosthesis and that needs to be documented in the chart.