Posted by Barry on 1/25/2013 to Health & Footwear
The short answer is, “maybe”. Medicare will cover the cost of one pair of extra-depth shoes (diabetic shoes) and three pairs of inserts for diabetics but only if they have a medical need for them. Extra-depth shoes may be medically necessary as a protection for insensitive feet or against diabetic neuropathy (nerve damage in the feet).
To qualify for reimbursement, the following conditions must be met:
- Your treating physician must complete a certificate of medical necessity for the shoes and document the need in your medical records.
- The shoes and inserts must be prescribed by a podiatrist or other qualified doctor and provided by a podiatrist, orthotist, prosthetist, or pedorthist.
In many cases, your doctor can take care of billing Medicare but if you receive your benefits through a Medicare Advantage Plan there may be other steps required. Check by calling your plan’s customer service department and inquiring about their requirements for diabetic shoe coverage.
In some cases when a patient cannot wear extra-depth footwear due to foot deformity, Medicare may cover the cost of one pair of custom-molded shoes (including inserts) and two additional pairs of inserts.
Qualifications for Reimbursement for Orthopedic Shoes & Inserts
To qualify for Medicare reimbursement of the cost of your diabetic shoes you must be covered under Medicare Part B and meet all three of the following conditions:
- You have diabetes and
- 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
- Poor circulation in either foot
Your doctor has certified your need in writing stating:
- 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
If you meet all the aforementioned conditions there are still other factors that may affect the amount of your reimbursement. Make sure you check with your doctor and plan provider.