UM Guidelines

	Changed Clinical Indications to include the following:
	Custom foot orthotics may be indicated...: ... Foot condition, as indicated by 1 or more of the following: [Diabetes, for prevention of complications] * ... Evidence Summary Criteria [APPLICABLE TENNESSEE STATE MANDATE REQUIREMENTS 56-7-2605. Equipment, supplies and outpatient services for diabetic patients. The following equipment and supplies for the treatment of diabetes must be included in the coverage provided pursuant to subsection (b), when prescribed by a physician as medically necessary for the care of an individual patient with diabetes: (J)  Podiatric appliances for prevention of complications associated with diabetes] *

References

Tennessee Code: Title 56 Insurance: Chapter 7 Policies and Policyholders: Part 26 Mandated Insurer or Plan Options: 56-7-2605. Equipment, supplies and outpatient services for diabetic patients. Retrieved August 7, 2023 from https://web.lexisnexis.com.