“Our office has decided to take the leap and do diabetic shoes for patients who see a Nurse Practitioner or a Physician’s Assistant. Has anyone had any luck with this? We are noticing that we are not hearing much about this since earlier this year.”
Here are the current rules for patients that see a nurse practitioner (NP) or a physician’s assistant (PA) in order to be certified for extra depth, therapeutic shoes and either heat molded or “custom” inserts. The following applies to both NPs and PAs that are providing healthcare services under the direct supervision of an MD or DO through “incident to” provisions. The DME MACs have indicated that CMS has offered guidance that allows NPs and PAs to certify the medical need for diabetic shoes when ALL the following conditions are met:
- 1. The supervising physician has documented in the medical record that the patient is diabetic and has been, and continues to provide, the patient follow-up under a comprehensive management program of that condition; and,
- 2. The Nurse Practitioner or Physician’s Assistant certifies that the provision of the therapeutic shoes is part of the comprehensive treatment plan being provided to the patient; and,
- 3. The supervising physician must review and verify (sign and date) all of the Nurse Practitioner’s or Physician’s Assistant’s notes in the medical record pertaining to the provision of the therapeutic shoes and inserts, acknowledging their agreement with the actions of the Nurse Practitioner or Physician’s Assistant.
It is important to note that the above does not apply to nurse practitioners that are practicing independently and billing under their own, personal NPI. They must be practicing under the direct supervision of either an MD or a DO.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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