What Foot Care Services Will Medicare Cover?
Annual foot exams or treatments may be covered by Medicare Part B if you have diabetes-related nerve damage or need medically necessary treatments for a related foot injury or disease. Medicare Part B may cover medically necessary treatments for injuries or disease such as hammer toe, bunion deformities, and heel spurs.
You will pay 20 percent of the Medicare-approved amount for the medically necessary treatment, and the Part B deductible will apply. However, for the treatment to be covered by Medicare Part B, you will also need a referral from your doctor. The amount you pay will be determined by whether your doctor accepts Medicare assignment. The amount you pay may also change based on other insurance you may have, how much your doctor charges, and the type of facility used for your treatments and testing. For example, in a hospital outpatient setting, you may also pay a copayment for medically necessary treatment.
Again, your costs and coverage may be different with a Medicare Advantage plan, but when it comes to Medicare Part B, if your foot care treatment isn’t medically necessary and/or you do not receive a doctor’s referral, you will generally have to pay 100 percent of the costs.
How Does Medicare Cover Diabetic Foot Care?
As noted above, Medicare Part B covers yearly foot exams or treatments if you have diabetes-related nerve damage . More specifically, Medicare will cover an annual foot exam if you have “diabetes-related lower leg nerve damage that can increase the risk of limb loss” and “you haven’t seen a footcare professional for another reason between visits.”
In general, Part B will cover 80 percent of the Medicare-approved amount, the Part B deductible applies, and if services are provided in a hospital outpatient setting, a copay may also apply. If you have other insurance or a Medicare Advantage plan, your costs may be different.
See below for some things Medicare may cover if you qualify, and if your doctor and the shoe or insert supplier are enrolled in Medicare.
A pair of custom-molded shoes and inserts
A pair of extra-depth shoes
Two additional pairs of inserts each calendar year (for custom-molded shoes)
Three additional pairs of inserts each calendar year (for extra-depth shoes)
Shoe modifications (if you don't use inserts)