If you have diabetes and Medicare Part B, you may be eligible to receive one pair of therapeutic shoes and up to three pairs of custom inserts every calendar year. Please be aware that you are still responsible for any applicable copay, co-insurance, or deductible amounts.

A prescription alone is not enough. Medicare requires specific documentation from your providers before we can fit you with therapeutic shoes. See Diabetic Shoes Documentation list below and bring this information to your doctor’s appointment.

Diabetic Foot Exam

Your provider must document at least one of the six qualifying foot conditions within the last 6 months. This exam must be performed and documented in your medical record.

Standard Written Order Form

This form must be completed in full. It must specify all items that are required and medically necessary for your care.

Print a copy to take your your next appointment: Standard Written Order Form

Diabetes Maintenance Progress Notes

Your certifying physician must have documented diabetes management and ongoing care within the last 6 months. These notes confirm that your diabetes is being actively treated.

Statement of Certifying Physician / CMN form

This is the final step. Complete steps 1–3 first, as this form expires in 90 days. If your certifying physician did not personally perform the foot exam, they must obtain, countersign, initial, and date the podiatrist’s exam before or on the same date as signing this form.

Print CMN form to take your next appointment: CMN for Diabetic Shoes and Inserts 

Please print all 3 documents to take to your doctor appointment:

  1. Documentation List
  2. SWO Form
  3. CMN / Statement of Certifying Physician Form

What happens next? Once we receive all four documents — either faxed directly from your doctor or brought in by you — our team will review them. If they meet Medicare’s requirements, we will contact you to schedule your evaluation and fitting appointment.

Questions? We’re here to help.
Carolina Healthcare Products Inc.
20 Medical Campus Drive, Suite 102 — Supply, NC 28462

Call (910) 755-6767
Email us
Fax (910) 230-5616