In simple words: This code covers a custom-made silicone shoe, molded to fit your foot exactly. It includes adjustments to ensure a comfortable fit. It's frequently used for individuals with diabetes who experience numbness in their feet. Medicare may cover the cost if it's deemed medically necessary and attached to a leg brace.

This code covers the supply of a silicone shoe fabricated from a model (replica or electronic image) of the patient’s foot, including fitting and adjustment. It is often prescribed for diabetic patients with loss of sensation in their feet. The shoe is made of a soft silicone inner material that helps accommodate pressure areas of the lower limb. Medicare coverage applies when the shoe is medically necessary and an integral part of a leg brace.

Example 1: A patient with severe diabetic neuropathy and foot deformities requires custom-made silicone shoes to protect their feet from pressure sores and ulcers. The shoes are an integral part of the prescribed leg braces, which provide stability and offloading., A patient with a Charcot foot deformity undergoes casting and is fitted with a custom silicone shoe to accommodate the changes in foot shape and protect against further complications. The shoe is attached to a brace for added support and pressure relief., Following surgical correction of a foot deformity, a patient is prescribed a custom-molded silicone shoe to protect the surgical site, reduce pressure on sensitive areas, and facilitate healing. The shoe is worn inside a brace for stabilization during ambulation.

Documentation should include the medical necessity for the shoe, its integration with a leg brace (if applicable), the patient's diagnosis (e.g., diabetes with neuropathy), and details of the custom fabrication process.