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Prescription Footwear Benefit Change

August 5, 2011

Medicaid Fee For Service announced that effective April 1, 2011 that the prescription footwear benefit was changed. Prescription footwear defined as orthopedic shoes, shoe modifications and shoe additions. TOTAL CARE must also follow these new benefit rules.

The coverage will be limited to:

Children under 21 years of age who require orthopedic footwear to correct, accommodate or prevent a physical deformity or range of motion malfunction in a diseased or injured part of the ankle or foot, or to support a weak or deformed structure of the ankle or foot.
Shoes attached to a lower limb orthotic brace
As a component of a comprehensive diabetic treatment plan to treat amputation, or pre-ulcerative calluses, or peripheral neuropathy with evidence of callus formation of either foot, or a foot deformity or poor circulation.

Pre-authorization for prescription footwear following the above criteria is still required. If the above conditions are not met, the services are not in the benefit package.

Apart from the above noted exceptions, All L codes listed in the Medicaid DME Provider Manual, (https://www.emedny.org/providermanuals/index.aspxas) as well as the codes for diabetic shoes, which are A550, A5501, A5503, A5504, A5505, A5506, A5507, A5512, and A5513 are excluded from coverage.