Our Diabetic Footwear Options

Medicare’s Therapeutic Shoe Bill

According to the American Diabetes Association, there are approximately 16 million Americans with diabetes. Unfortunately, this number continues to grow. Twenty-five percent of persons with diabetes develop foot problems related to the disease. Recognizing this problem, Congress approved the Medicare Therapeutic Shoe Bill; helping thousands of persons with diabetes obtain protective footwear and inserts.

Medicare Beneficiary Eligibility

Medicare covers diabetic shoes, inserts & modifications for program beneficiaries only if the following criteria are met:

                          (a) The patient has diabetes and one or more of the following conditions:  

                                   1.  Previous amputation of the other foot, or part of either foot.

                                   2.  History of previous foot ulceration of either foot.

                                   3.  History of pre-ulcerative calluses of either foot. 

                                  4.  Peripheral neuropathy with evidence of callus formation of either foot.

                                  5.  Foot deformity of either foot.

                                  6.  Poor circulation of either foot.

                        (b) The certifying physician who is managing the patient’s systemic diabetes condition has certified that:

                                  1.  One or more of the indications required by (a) above are present.

                                  2.  He or she is treating the patient under a comprehensive plan of care for his or her diabetes.

                                  3.  The patient needs diabetic shoes, inserts or modifications.

What is Covered? Coverage Limitations

For Medicare beneficiaries meeting criteria described above, coverage is limited to one of the following within 1 calendar year:

• 1 pair of off-the-shelf depth shoes and 3 additional pairs of multi-density inserts.

• 1 pair of off-the-shelf depth shoes including a modification, and 2 additional pairs of multi-density inserts.

• 1 pair of custom-molded shoes and 2 additional pair of multi-density inserts

Your Costs in Original Medicare

After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount (if your supplier accepts assignment).

Medicare will only cover your therapeutic shoes if your doctors and suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren't enrolled, Medicare won't pay the claims they submit.  The specific amount you'll owe may depend on your contract with Medicare and any other health insurance you may have including deductibles, co-insurance and co-pays.