Ohio Administrative Code
Title 5160 - Ohio Department of Medicaid
Chapter 5160-10 - Medical Supplies, Durable Medical Equipment, Orthoses, and Prosthesis Providers
Section 5160-10-31 - DMEPOS: footwear and foot orthoses

(1) No particular form or format is specified for the certification of medical necessity.

(2) Payment may be made for an orthopedic shoe only if at least one of the following conditions is met:

(3) Greater frequency of shoe replacement may be allowed for individuals younger than eight years of age. Payment for shoe replacement beyond an established frequency for individuals younger than twenty-one years of age is subject to prior authorization (PA).

(4) No payment is made for an orthopedic shoe that is to be worn over a prosthesis.

(5) Payment for a foot orthosis includes the acquisition (by casting or other means) of the model on which the orthosis is constructed.

(1) The shoe is to be worn over an orthotic device; and

(2) Commercially available shoes that fit over the orthotic device would be unacceptably long or otherwise ill-suited to ambulation.

(1) The default certificate of medical necessity (CMN) form is the ODM 01912, "Certificate of Medical Necessity: Therapeutic Footwear for Individuals with Diabetes" (rev. 7/2018). The CMN includes an attestation that all of the following statements are true:

(2) Therapeutic footwear may be prescribed only by a podiatrist, pedorthist, orthotist, prosthetist, or other qualified practitioner who manages the individual's diabetes.

(3) Therapeutic footwear may be fitted and dispensed only by a podiatrist, pedorthist, orthotist, or prosthetist.

(4) Payment may be made for therapeutic footwear (shoes, inserts, or shoe modifications) only if the individual has diabetes mellitus and at least one of the following conditions is met:

(5) Payment may be made for a custom-molded shoe only if the individual has a foot deformity that cannot be accommodated by a depth shoe. The nature and severity of the deformity is to be well documented in the provider's records. If there is insufficient evidence of need for a custom-molded shoe, then payment will be limited to the cost of the least expensive medically appropriate alternative.

(6) No payment is made for the following items:

(7) Payment for a therapeutic shoe includes fitting, necessary inserts, and any necessary modification. Separate payment may be made for inserts if the provider confirms in writing that the individual has appropriate footwear meeting the industry definition of a depth or custom-molded shoe, into which the insert can be placed.