Medicare Guidelines for Diabetic Shoes and Inserts

Posted on: March 23rd, 2015 by JPO Blogger
Not sure what Medicare will cover when it comes to your diabetes? Check out the requirements for shoes and inserts.

Not sure what Medicare will cover when it comes to your diabetes? Check out the requirements for shoes and inserts.

A pedorthic device is created to treat a variety of possible foot-related problems such as congenital deformity, improper walking and partial foot amputations. If you are covered by Medicare Part B, you qualify for therapeutic shoes and/or inserts. Medicare coverage can help prevent suffering while saving you money!

Medicare Part B covers one pair of therapeutic shoes and/or inserts and one fitting each calendar year. In some cases, Medicare will also cover shoe modifications in place of inserts. If you qualify, you are limited to one of two types of the following shoes each year:

  • One pair of depth-inlay shoes and three pairs of inserts
  • One pair of custom-molded shoes if you can’t wear depth-inlay shoes because of a foot deformity, and two addition pairs of inserts.

In order for Medicare to cover the cost of your therapeutic shoes, the doctor treating your diabetes must verify that you meet three conditions:

  1. You have diabetes
  2. You have least one of the following conditions in one or both feet:
    • Partial or total foot amputation
    • Foot ulcers
    • Preulcerative calluses
    • Nerve damage due to diabetes
    • Poor circulation
    • Foot deformity
  3. You are receiving treatment through a comprehensive care plan and need therapeutic shoes and/or inserts

Medicare also requires that:

  • Your doctor confirms your need for therapeutic shoes or inserts.
  • A podiatrist or other qualified doctor prescribes them.
  • Your items are provided by a podiatrist, orthotist, prosthetist or pedorthist

Typically, Medicare will pay 80 percent of the amount owed either directly to you or through a reimbursement. You are responsible for a minimum of 20 percent of the total payment amount. However, Medicare pays for different kinds of equipment differently depending on other insurance you have, how much your doctor charges, the type of facility, etc.

If you are in need of a therapeutic shoe or insert, talk to JP&O! We have trained pedortists who are trained to build shoes and applications to improve your function and get rid of pain. We can also help you figure out the complicated insurance and billing information. Contact JP&O today!

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