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Criteria for Therapeutic Shoes for Diabetes

Approved: 6/14
Reviewed: 2/15, 1/16, 12/16, 1/17
Revised:

 

Diabetic shoe requirements. Diabetics must have one of the following (coverage can be provided if only one foot is affected):

  • Foot deformity
  • History of previous foot ulcers
  • History of pre-ulcerative calluses
  • Peripheral neuropathy that has led to callus formation/problems
  • Poor circulation
  • Complete or partial foot amputation.

One of the following types of shoes is covered per calendar year as deemed medically necessary.

Types of shoes covered:

  • One pair of depth inlay shoes and 3 pairs of inserts
  • One pair of custom molded shoes (including inserts provided with the shoes) and 2 additional.  Custom molded shoes are only indicated if depth-inlay shoes cannot be worn due to foot deformity.

A depth shoe can be described as having a full length, heel-to-toe filler that provides a minimum of 3/16” of additional depth designed to accommodate the custom inserts. The depth shoe must have some type of closure (Velcro, laces, zipper), they cannot be slip on. These shoes must also be made of leather or other suitable material of equal quality. The depth shoe must be made available in full and half sizes with a minimum of 3 widths so that the sole is graded to the side and width of the upper portions of the shoes according to the American standard sizing schedule or its equivalent.

A custom molded shoe is defined as having removable inserts which can be altered or replaced as the individuals condition changes. They are constructed over a positive model or mold of the individuals foot. Just like the depth shoe they must be made of leather or other similar quality material and have to have some type of closure. They cannot be slip on.

Some of the inserts may need to be altered/modified to help the shoe fit correctly. Examples of modifications:

  • Flared/offset Heels
  • Wedges
  • Rigid rocker bottoms
  • Roller  bottoms
  • Inserts for missing toes

Cosmetic features such as shoe style, shoe color or types of leathers are not considered medically necessary because they do not contribute to the therapeutic function of the shoe.

ConnectCare

Utilization Management

ConnectCare's Utilization Management Staff is available to address questions and issues related to case management and utilization by using the telephone or fax numbers listed below.

ConnectCare Medical Management
4000 Wellness Drive
Midland, MI 48670
Toll free: 888-646-2429
Local: 989-839-1613
Fax: 989-839-1679
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.

Certified by NCQA since 2007

NCQA Certified Utilization Management"Achieving Utilization Management Certification from NCQA demonstrates that ConnectCare has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards." -- Margaret E. O'Kane, President, NCQA

NCQA has reviewed and certified ConnectCare's Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.