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 § 56-7-2605. Equipment, supplies and outpatient services for diabetic patients. Retrieved June 24, 2025 from  https://codes.findlaw.com/.