Tips for Getting Medicare to Pay for Diabetic Shoes and Inserts
Diabetes, a disease that disrupts your body’s ability to convert food into energy, can give rise to severe consequences affecting your heart, nerves, kidneys, eyes and feet. While there is no cure, there are programs available to work with you and your doctor to take the necessary steps to manage the condition.
Medicare Benefits Solutions
Apr 11, 2022
The Impact of Diabetes on Your Feet
Nerve damage and poor blood flow are both common complications of diabetes and can affect your mobility and independence if your feet are affected. Podiatrists can help patients manage or circumvent foot-related difficulties due to diabetes.
The American Podiatric Medical Association (APMA) offers patients with diabetes these foot care tips:
- Each day, examine your feet and toes, looking for cuts, sores, discoloration, bruises, swelling, numbness and dry cracks.
- Check your toenails for thickening and discoloration.
- Choose socks that are thick and soft.
- Manage your weight and circulation by exercising regularly while ensuring your shoes are appropriate for the activity.
- Wear appropriate footwear, even at home, and refrain from going barefoot to avoid cuts and infection on your feet.
- Only a qualified doctor should remove skin growths or thickened skin, such as calluses, warts or corns.
- Ensure you are wearing shoes that have been carefully measured and fitted, keeping in mind that the size and shape of your feet can change over time.
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Foot Health Diagnosis and Treatment
Medicare Part B covers an annual visit to your doctor for foot care if one of these applies:
- You have nerve damage in your lower leg related to diabetes, which may increase the chances of losing a limb
- You have a medically necessary need for treatment related to injuries or diseases related to your feet, such as hammertoes, heel spurs and bunion deformities
Your share of the cost is the Part B deductible and coinsurance. If treated in a hospital outpatient center, you may also have to pay a copayment.
According to rules set by the Centers for Medicare & Medicaid Services (CMS), the certifying physician who diagnoses and treats your diabetic condition must be a medical doctor (MD) or doctor of osteopathy (DO). CMS also addresses Medicare’s coverage of shoes, inserts and other footwear for people with diabetes.
Will Medicare Pay for Shoes for Diabetics?
If you have diabetes and severe foot disease related to diabetes, Medicare Part B covers one pair of medically necessary custom-molded shoes and inserts. Alternatively, you can get one pair of extra-depth shoes.
Part B also covers:
- Two additional pairs of inserts for custom-molded diabetic shoes
- Three pairs of inserts for extra-depth diabetic shoes
- Shoe modifications rather than inserts
How Often Will Medicare Pay for Diabetic Shoes?
If you have Part B, you are eligible for benefits for diabetic shoes and inserts once per calendar year.
Criteria for Coverage
CMS established the following criteria for coverage of therapeutic shoes, inserts and modifications:
- You have a diagnosis of diabetes mellitus from a certifying physician.
- The certifying physician has documented your medical history of foot complications, such as amputation, ulceration, pre-ulcerative calluses, peripheral neuropathy, deformity or poor circulation.
- You must meet with your certifying physician within six months before your shoes and inserts are delivered. The physician must sign a certification statement within three months before delivering the items.
- Your supplier must perform and document an in-person evaluation.
- At the time of delivery, the supplier must document an assessment of how the shoes and inserts fit.
How do I Get Medicare to Pay for Diabetic Shoes?
Before purchasing diabetic shoes, confirm that both your doctor and the diabetic shoe supplier are enrolled in Medicare. Medicare will not pay claims submitted by providers who are not enrolled.
Ask suppliers if they participate in Medicare. Only participating suppliers are required to accept assignment. By accepting assignment, the supplier agrees to charge you only the coinsurance and deductible. This rule applies to any durable medical equipment items you purchase, such as wheelchairs, walkers and orthotics.
When you purchase diabetic shoes from a participating supplier, your share of the cost is limited to:
- 20% of the Medicare-approved amount
- Part B deductible, which is $233 in 2022
How Do I Get Reimbursed From Medicare for Diabetic Shoes?
Participating suppliers generally bill Medicare or Medicare Advantage directly. Note that Medicare Advantage plans have their own provider networks, so check your plan benefits and provider directory before making your purchase.
If you have a Medigap policy to supplement Original Medicare, check your plan for coverage of the Part B coinsurance. Most Medigap plans pay the Part B coinsurance at 100% for covered services, with the exceptions of Plan K and Plan L, which cover part of the coinsurance. Unless you purchased a Plan C or Plan F prior to January 1, 2020, you will still be responsible for the Part B deductible.
Diabetic Shoes Near Me
The prescribing practitioner who writes the order for diabetic shoes and inserts may be a podiatrist, medical doctor (MD), doctor of osteopathy (DO), physician assistant (PA), nurse practitioner (NP) or a clinical nurse specialist. Your prescribing practitioner may also be the supplier that furnishes your shoes, inserts or modifications.
If the practitioner refers you to a supplier, confirm that the supplier is enrolled in Medicare and accepts assignment. If you are a Medicare Advantage member, ensure that the supplier participates in your plan’s network.
In addition to your MD or DO, be sure to arrange regular checkups with an ophthalmologist to check blood flow to your eyes, a dentist to look for gum issues resulting from excess blood sugar, and your primary physician to provide appropriate referrals. The APMA asserts that diabetes “can be controlled successfully with guidance and treatment from a team of medical specialists.”