01/16/2023

Obtaining Prior Auth for Diabetic Shoes

Is there a list of insurances that requires diabetes shoes prior authorization including Medicare advantage plans and Medicaid plans. Is DME number sufficient for both Medicare and Medicaid plans. Or is one required to get a DME number from NYS in order to dispense diabetic shoes to Medicaid patients? Thanks in advance.

There is no list available that informs providers of what plans require prior authorization for diabetic shoes and inserts. Because of the large number of different plans available between commercial, Medicaid and Medicare policies, it is recommended to verify if pre-certification is required under the patient’s policy when verifying their insurance eligibility for a visit. The PTAN used for billing DMERC for Medicare beneficiaries is not valid for billing FFS NYS Medicaid. Podiatrists do not meet the criteria for being a durable medical equipment supplier for Medicaid. Even if an item is medically necessary and paid by Medicare or any other primary insurance, FFS Medicaid will not reimburse any patient responsibility due to a provider specialty restriction, and any balance will have to be written off since a patient cannot be held liable.