Medicare will cover the cost of one pair of therapeutic shoes (diabetic shoes) and inserts for people with diabetes if you have a medical need for them. The Medicare payment for therapeutic shoes is subject to the requirement that they are necessary and reasonable for protection of insensitive feet or neuropathy (nerve damage in the feet) or peripheral arterial disease (poor circulation) . To ensure that Medicare pays for your shoes, you must follow the steps below:
- Your treating doctor must complete a certificate of medical necessity for the therapeutic shoes and document the need in your medical records. Do not order anything until you have visited your doctor – no matter what the sales person tells you.
- The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.
- The supplier must receive the order before Medicare is billed and must keep it on file.
- If you receive your Medicare through a Medicare Advantage Plan (like an HMO or PPO) it is likely you will have to follow the plan’s steps for approval and purchase. Make a point of calling your plan’s customer service number and ask about their steps for coverage of diabetic shoes.
Find out if you qualify for Medicare covered diabetic services and supplies.
Medicare will cover one of the following per calendar year:
- One pair of depth-inlay shoes and three pairs of inserts or;
- One pair of custom molded shoes (including inserts) and two additional pairs of inserts. This option is only available if you cannot wear depth-inlay shoes due to a foot deformity.
- In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.
Medicare will not cover deluxe features: A deluxe feature is one that does not contribute to the shoe’s therapeutic function – for example, a custom style, color or custom material.
How Do I Qualify for the Coverage of Diabetic Shoes?
You must be covered under Medicare Part B and all three of the following conditions are met:
1. You have diabetes and;
2. You have one or more of the following conditions:
- Partial or complete foot amputation
- Past foot ulcers
- Calluses of either foot that could lead to ulcers
- Nerve damage in your feet with signs of calluses on either foot
- Deformity of either foot (for example, hammertoe or bunions)
- Poor circulation in either foot.
3. Your doctor has certified your need in writing, and it states that:
- You meet the criteria for the shoes
- The doctor (must be an M.D. or D.O.) is treating you under a comprehensive plan of care for diabetes
- The exact reasons you need the therapeutic shoes and/or inserts
- Only an M.D. or D.O. can sign the certification statement; a podiatrist may write the prescription for the shoes, but the M.D. or D.O. who is treating your diabetic condition must certify it. While a podiatrist can prescribe diabetic shoes, they cannot sign the physician’s certification statement.
- You will need a new order for the replacement of any shoe
- A copy of the certification statement and prescription must be kept on file by your supplier
- A new certification statement will be required for shoes, inserts or modifications each year they are purchased