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How to use or fill out 2014 DIABETIC FOOTWEAR PRESCRIPTION FORM with our platform
- Click ‘Get Form’ to open the 2014 DIABETIC FOOTWEAR PRESCRIPTION FORM in the editor.
- Begin by entering the patient's name, ID number, and date of birth in the designated fields at the top of the form.
- Indicate the appropriate ICD-9 code for the diagnosis. Ensure that you include a two-digit ending as specified.
- In the section labeled 'Patient must have at least ONE of the following', circle all applicable conditions that justify medical necessity for diabetic footwear.
- For inserts, check the number of pairs required under both direct mold inserts and custom inserts sections.
- Fill out any additional modifications needed, such as custom toe fillers or rocker bottom soles, ensuring to circle only one option where indicated.
- Complete the special Rx instructions if necessary and provide prescribing physician information including name, signature, date, address, NPI number, and phone number.
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What is the CPT code for diabetic footwear?
Diabetic Footwear HCPCS Code range A5500-A5514.
Who can write a prescription for diabetic shoes?
Podiatrists, physicians assistants, nurse practitioners, and clinical nurse specialists can write prescriptions for therapeutic footwear. However, docHubing physicians must provide documentation that they personally examined a patients feet or otherwise verify the exam performed by one of these other care providers.
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