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Click ‘Get Form’ to open the STATEMENT OF CERTIFYING PHYSICIAN FOR THERAPEUTIC SHOES/INSERTS in our editor.
Begin by entering the patient's name in the designated field at the top of the form.
Review and circle all applicable conditions that apply to the patient, such as history of foot ulcers or peripheral neuropathy.
Confirm that you are treating the patient under a comprehensive diabetes care plan by checking the relevant box.
Indicate whether special shoes are needed due to diabetes by checking the appropriate option.
Fill in your name, designation (M.D. or D.O.), address, NPI number, and phone number in the specified fields.
Finally, sign the document electronically using our platform’s signature feature to complete the form.

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What is the therapeutic shoe bill?

Physician complete all required paperwork: o Statement of docHubing Physician for Therapeutic Shoes o Prescription/Standard Written Order o Office Visit Notes from prescribing provider and physician that treats your diabetes. These evaluations must be within 6 months prior to receiving your shoes and/or inserts.

How to get free shoes from Medicare?

Medicare will only cover your orthopedic shoes if your doctors and suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers arent enrolled, Medicare wont pay the claims they submit.

What is the Therapeutic shoe Act?

This bill would authorize NPs and PAs to docHub a Medicare beneficiarys need for therapeutic shoes, improving timeliness and access to care while reducing costs. The Promoting Access to Diabetic Shoes Act is endorsed by the American Association of Nurse Practitioners and the American Academy of Physician Associates.

Does Medicare cover therapeutic shoes?

Medicare will only cover your therapeutic shoes if your doctors and suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare.

What to document for diabetic shoes?

Orthotics refers to custom-made shoe inserts prescribed by a licensed doctor of podiatric medicine, an osteopathic doctor, or a medical doctor after a medical examination and diagnosis. Orthotics are designed to accommodate or correct an abnormal or irregular walking pattern.

shoes order form

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STATEMENT OF CERTIFYING PHYSICIAN FOR THERAPEUTIC SHOES/INSERTS 2026

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How to use or fill out STATEMENT OF CERTIFYING PHYSICIAN FOR THERAPEUTIC SHOES/INSERTS with DocHub

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Got questions?

What is the therapeutic shoe bill?

How to get free shoes from Medicare?

What is the Therapeutic shoe Act?

Does Medicare cover therapeutic shoes?

What to document for diabetic shoes?

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STATEMENT OF CERTIFYING PHYSICIAN FOR THERAPEUTIC SHOES/INSERTS 2026

Here's how it works

How to use or fill out STATEMENT OF CERTIFYING PHYSICIAN FOR THERAPEUTIC SHOES/INSERTS with DocHub

See more STATEMENT OF CERTIFYING PHYSICIAN FOR THERAPEUTIC SHOES/INSERTS versions

Complete this form in 5 minutes or less

Got questions?

What is the therapeutic shoe bill?

How to get free shoes from Medicare?

What is the Therapeutic shoe Act?

Does Medicare cover therapeutic shoes?

What to document for diabetic shoes?

shoes order form

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