Reimbursement&codingNews
Medicaid
Prescription
Footwear and
Stocking Benefit
Update
On December 9, 2013, Judge Charles
J. Siragusa ruled that the limitations on
medically necessary orthopedic footwear
and compression stockings applied as a
result of April 1, 2011 amendments to
New York Soc. Serv. Law § 365-a(2)(g)
(iii) and (iv) can no longer be applied
in Medicaid coverage determinations.
(Davis v. Shah, W.D.N.Y., 12-CV-6134).
In 2011, PFA lobbied the New York
State Medicaid Redesign Team strongly
opposing the proposed changes to
Medicaid coverage criteria and payment
methodology for therapeutic footwear.
Effective December 9. 2013, the
Medicaid program is returning to medical
necessity criteria applied prior to the April
1, 2011 State law amendments.
• The criteria for coverage of medically
necessary prescription footwear, shoe
modifications and additions is no longer
limited to diabetics, children under the
age of 21, or for use as part of a lower
limb brace.
• The criteria for coverage of medically
necessary compression and support
stockings coverage is no longer
limited to use during pregnancy or for
treatment of open venous stasis ulcers.
For additional information refer to the
Provider Communication “Medicaid
Prescription Footwear and Stocking
Benefit Update” located in the DME
manual at eMedNY.org.
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Sizes & Widths
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52
Pedorthic Footcare Association www.pedorthics.org
9205-L