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Universal City 210-375-3318
Pleasanton 830-569-FEET (3338)
Toll-Free: 855-972-9512
Next Step Foot & Ankle Clinic

Will Medicare cover the cost of a diabetic shoe?

Insurance formEffective December 1, 2016.  Next Step Foot & Ankle Clinic will not be participating in any insurance carrier's diabetic shoe program.  This includes the Medicare Therapeutic Shoe Program.  We will continue to offer Diabetic Shoes for those who wish to pay for the shoes and inserts on their own.  

 

 

Diabetes can be dangerous to your feet. Even a small cut can have consequences. Diabetes may cause nerve damage that takes away the feeling to your feet, making it harder to heal an injury or resist infection.

In 1993, Congress passed the Medicare Therapeutic Shoe Bill, which allows qualified persons to receive Medicare assistance for protective shoes and inserts.

Diabetic shoes and prescription inserts are intended to help prevent more serious foot health complications that can arise as a result of diabetes.

Can you answer yes to any of these foot problems?

  • Poor Circulation
  • Foot Deformities
  • Pre-ulcerative callus formulation or peripheral neuropathy with a history of callus formation
  • History of previous foot ulceration
  • Previous amputation of the foot or part of the foot

If you are a qualifying diabetic, Medicare and your supplemental insurance may reimburse for all or part of the cost of your Dr. Comfort shoes and prescription inserts.

Medicare allows one pair of Diabetic shoes per calendar year for patients who are being treated by their Primary Care Physician for diabetes or other qualifying peripheral vascular disease. Medicare requires a few things of their patients who want their diabetic shoes to be covered:

  1. Patient must be in a current treatment regimen by their Primary Care Physician for a qualifying condition such as diabetes or peripheral vascular disease.
  2. We must submit to Medicare clinical notes from your Primary Care Provider showing a face to face visit with your Medical Doctor (not a Physician's Assistant or Nurse) within the previous 6 months. These notes must document treatment of diabetes or the qualifying condition and must be signed and dated by the MD who provided the clinical notes.
  3. In addition, your MD must sign and date a Certifying Physician Statement noting the condition that qualifies you for Diabetic Shoes under the Medicare program and at least one other condition, such as a deformity that requires accommodation, peripheral neuropathy with callus formation.

Next Step Foot & Ankle Clinic will provide you with a brochure you can take to your Primary Care Physician that is managing your diabetes to see if you qualify and get your paperwork started. This brochure explains the process for both you and your doctor and includes simple 1-2-3 instructions, along with the forms your doctor will need to complete. It also has some important facts about diabetes foot health. (Click here to see it.)

As with all Medicare claims, Medicare pays 80% after the annual deductible is met, and the patient is responsible for their 20%. We will work with you to see if this is a covered benefit for you. We submit claims to Medicare for our patients electronically. Private insurance and cash patients may also obtain shoes from our office.   Please call us to begin your claim at 210.375.3318.