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05/16/2002    Richard Stess, DPM

Can a DPM Prescribe and Dispense Custom Shoes and AFO’s

Query: Can a DPM Prescribe and Dispense Custom
Shoes and AFO’s
From: Richard Stess, DPM

We would like an opinion regarding podiatrists
being both a prescriber and dispenser for custom
shoes and AFO's. Is this addressed by the Stark
bill II ? Any changes between Stark I and II
regarding this subject?

Richard Stess, DPM


Response From Josh White, DPM, C.Ped

Podiatrists are permitted to dispense items,
reimbursed by Medicare, that they have
prescribed, so long as it is done in their own
office. A good reference for clarification of
the rules addressing physician self referral
(Stark II) can be found on the link

Included in this is a reference to the
term "Referral".

"Definition of "Referral." The final rule
revises the definition of "referral" to exclude
services personally performed by the referring

Additionally, under the law, diabetic shoes are
not considered to be included as orthotics,
prosthetics or prosthetic devices and so the
Stark II law does not even apply.

For further information, Joanne Sinsheimer at
the Department of Health and Human Services is
available at (410) 786.4620.

Josh White, DPM, CPed
New York City, NY
Medical Director, SafeStep


Editor’s comment: PM News does not provide legal
advice. The recently released Stark II
provisions are contained in a 600 page document.
In general, Stark II tends to be more liberal
than Stark I in that it expands on the safe
harbor exceptions to the self-referral
prohibitions of the original law.

If a podiatrist is merely prescribing and
dispensing a custom shoe or AFO, there should be
no problem with Stark I or II.

Stark problems would arise if you prescribed a
custom shoe and sent the patient to a shoe store
owned by your wife, or if whomever you referred
the patient to, sent you a kickback or any

Since the Stark Laws are complex and situation
dependent, the advice of legal counsel should
always be sought when confronted with a
potential Stark problem.

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