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Improve Medicare Patient Access to Needed Diabetic Shoes

ACTION NEEDED: Cosponsor S. 800/H.R. 4870, the Promoting Access to Diabetic Shoes Act, which would authorize nurse practitioners (NPs) to certify their Medicare patients’ need for therapeutic shoes.


NPs play an important role in managing and delivering health care to their patients. They have been providing primary, acute and specialty health care to patients for over half a century and have been authorized Part B Medicare providers since 1998, including being recognized to furnish, order and refer for services and durable medical equipment (DME) under their Medicare provider numbers. The majority of the more than 325,000 practicing NPs in the country are primary care providers. NPs have prescriptive authority in all 50 states and the District of Columbia. In addition to treating acute and chronic illnesses of patients, NPs emphasize health promotion and disease prevention in all their undertakings.

NPs have demonstrated the ability to deliver high-quality, cost-effective care to the patients they serve. They have expert knowledge that allows them to provide high-level assessments of patient needs. They are particularly skilled in the management of diabetic patients, as evidenced by a recent study supported by the Veterans Health Administration which found that nurse practitioner management of patients with diabetes lowered health care costs due to fewer readmissions and emergency department visits. Early intervention involving diabetic shoes has been shown to reduce ulcerations and resulting complications, improve quality of life, and reduce health care spending. According to the American Diabetes Association, therapeutic shoes are a recommended therapy when clinically indicated. Given NPs’ proven track record for the care of patients with diabetes, it is inconsistent and problematic that NPs are recognized as Part B Medicare providers who can order DME but are still not authorized to certify their Medicare patients with diabetes need for therapeutic shoes.

Currently, an NP’s patient must undergo the following multistep process to obtain medically necessary therapeutic shoes under Medicare: the NP, who is treating the patient with diabetes, determines that the patient has a condition requiring diabetic shoes; then the NP must send the patient to a physician to make the same determination and to take over the patient’s care related to diabetes; the physician then refers that patient to a “podiatrist or other qualified individual” to fit and furnish the shoes.

Passage of legislation addressing this issue will make it possible for NPs to continue providing high quality care to their Medicare patients with diabetes. It will also reduce Medicare spending by eliminating duplicative services, while improving the timeliness of care for patients with diabetes who need therapeutic shoes.


AANP calls on Members of Congress to cosponsor S. 800/H.R. 4870, the Promoting Access to Diabetic Shoes Act, to authorize nurse practitioners (NPs) to certify their Medicare patients’ need for therapeutic shoes.

For additional information, please contact the AANP Government Affairs Office at 703-740-2529 or

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