Diabetic Forms Medicare Therapeutic Shoe Program: The Fitted Foot participates in this Medicare program that allows individuals who are diagnosed with diabetes (and who meet certain criteria) to obtain one pair of shoes per year. Medicare will cover 80 percent of the cost. Secondary insurance may cover the rest; but the individual is responsible for the amount not covered by insurance. Three pairs of custom multidensity foot orthoses are also covered by Medicare for individuals with diabetes who qualify to participate in the program. You can download the certificate of medical necessity (CMN) that must be signed by your primary care physician in order to obtain insurance coverage for your shoes. Click here to download the certificate of medical necessity.

Other Diabetic Forms

• Medicare Dmepos Suppliers Standers
• Customer Demographics
• Privacy Act – HIPPA
• Diabtic Foot Care for TSD
• Patients Rights and Responsibilities Policy
• Patient Satisfactory Survey
• Patients Bill of Rights

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