Medicare provides coverage for extra-depth shoes, custom-molded shoes, and shoe inserts for people with diabetes who qualify under Medicare Part B. Designed to prevent lower-limb ulcers and amputations in people who have diabetes, this Medicare benefit can prevent suffering and save money.
How Individuals Qualify
The M.D. or D.O. treating the patient for diabetes must certify that the individual:
1. Has diabetes.
2. Has one or more of the following conditions in one or both feet:
- history of partial or complete foot amputation
- history of previous foot ulceration
- history of preulcerative callus
- nerve damage because of diabetes with signs of problems with calluses
- poor circulation
- foot deformity
3. Is being treated under a comprehensive diabetes care plan and needs therapeutic shoes and/or inserts because of diabetes.
Type of Footwear Covered
If an individual qualifies, they are limited to one of the following footwear categories within one calendar year:
1. One pair of extra-depth shoes and three pairs of inserts
2. One pair of custom-molded shoes (including inserts) and two additional pairs of inserts.
Separate inserts may be covered under certain criteria. Shoe modification is covered as a substitute for an insert, and a custom-molded shoe is covered when the individual has a foot deformity that cannot be accommodated by an extra-depth shoe.
Meeting Medicare Requirements
In order to receive payment for therapeutic shoes and inserts, Medicare also requires:
- A podiatrist or other qualified doctor to prescribe the shoes
- A doctor or other qualified professional, such as a pedorthist, orthotist, or prosthetist fits and provides the shoes
Note that in most cases the certifying physician and the prescribing physician will be two different individuals.
Patient Responsibility for Payment
Medicare will pay for 80% of the Medicare-approved amount either directly to the patient or by reimbursement after the Part B deductible is met. The patient is responsible for a minimum of 20% of the total payment amount and possibly more if the dispenser does not accept Medicare assignment and if the dispenser's usual fee is higher than the payment amount.
Medicare pays only for therapeutic footwear from Medicare-approved suppliers, reimbursing 80% of the cost either to the patient or after the Part B deductible is met. The patient is responsible for the other 20% -- or more if the supplier does not "accept assignment" from Medicare.
