FAQs for Australians: How to Bill for Diabetic Shoes

If you are a healthcare provider or podiatrist in Australia, billing Medicare for diabetic shoes can be confusing. Understanding the rules ensures patients get the support they need while complying with government requirements. Here’s a clear FAQ guide to help you navigate the process.

1. Who can bill Medicare for diabetic shoes?

Podiatrists, GPs, and specialists can write prescriptions for diabetic shoes.
Approved providers and footwear suppliers can bill Medicare on behalf of the patient.
Patients cannot claim directly unless using the Medicare online claiming system via an approved provider.

2. What paperwork is required?

To bill Medicare, you need:

A valid prescription from a GP or accredited podiatrist.
The patient’s Medicare details (Medicare card number).
Invoice or receipt detailing the therapeutic shoes and/or orthotics provided.
Item codes relevant to the service (see below).

3. Which Medicare item codes are used?

For diabetic shoes, the typical items include:

Item 10962 / 10961 – custom-made orthotics for therapeutic footwear (specific codes depend on state and type).
Item 10972 / 10971 – extra-depth or custom-made shoes for people with diabetes.

Tip: Always check the latest Medicare Benefits Schedule (MBS) for current item numbers.

4. How much does Medicare pay?

Medicare provides a partial rebate, not the full cost.
Rebates differ based on:
- Whether shoes are standard extra-depth or fully custom-made.
- Whether orthotics are included.
The provider may charge the patient for the gap, i.e., the difference between the Medicare rebate and the actual cost.

5. Can providers bill Medicare directly?

Yes. Most podiatrists and approved suppliers can bulk bill or submit claims online via Medicare. Patients can also pay upfront and submit a claim for reimbursement if needed.

6. How often can you bill Medicare for diabetic shoes?

Typically once per patient per year.
Exceptions may apply if the patient’s foot size or medical condition changes.
Always document medical justification for early replacements to avoid claim rejection.

7. What supporting documentation should be kept?

Providers must retain:

Prescription details
Patient medical history showing foot risk
Invoice/receipt of shoes and orthotics
Any correspondence regarding rebates or special approvals

This ensures compliance in case of audits by Medicare.

8. Common mistakes to avoid when billing

Using incorrect item codes or outdated MBS codes
Failing to document the patient’s medical need
Billing more than once per year without justification
Submitting claims for non-therapeutic footwear

9. Tips for smooth Medicare billing

Verify the patient’s eligibility and prescription before ordering shoes.
Use approved suppliers familiar with Medicare claims.
Keep all records in line with the Medicare retention policy.
Communicate the gap payment clearly to patients to prevent misunderstandings.

Bottom Line:
Billing Medicare for diabetic shoes in Australia requires the correct prescriptions, item codes, and documentation. By following Medicare rules, providers can ensure patients receive the support they need while avoiding claim rejections or compliance issues.