Medicare Coverage For Therapeutic Shoes & Inserts

What Is the Therapeutic Shoe Program For Diabetes?

Congress enacted the Therapeutic Shoe Program for Diabetes (TSPD) in 1993 to allow qualified individuals with diabetes to receive protective footwear and inserts. The program was designed to prevent lower limb ulcers, amputations, and other complications in people who suffer from the disease.

In fact, a comprehensive foot health program can be an integral part of managing a patient’s diabetes and can help in preventing more serious complications resulting from impaired sensation in the feet.

Who Is Eligible?

If you have been diagnosed with diabetes and have Medicare Part B, and you meet the conditions outlined below, Medicare will cover therapeutic shoes if they are needed.

What Is Covered?

For Medicare to pay for therapeutic shoes, the doctor treating the patient’s diabetes must certify that the patient meets these 3 conditions:

1. The patient has diabetes.
2. The patient has at least one of these conditions in one or both feet:
   1. Partial or complete foot amputation
   2. Past foot ulcers
   3. Calluses that could lead to foot ulcers
   4. Nerve damage because of diabetes with signs of problems with calluses
   5. Poor circulation
   6. A deformed foot
3. The patient is being treated under a comprehensive diabetes care plan and needs therapeutic shoes and/or inserts because of diabetes.

Medicare also requires:

• A podiatrist or other qualified doctor prescribes the shoes
• The shoes must be provided and fit by a doctor or other qualified individual like a pedorthist, orthotist, or prosthetist

The types of shoes that are covered each calendar year include one of the following:

• One pair of depth-inlay shoes and 3 pairs of inserts
• One pair of custom-molded shoes (including inserts) if you can’t wear depth-inlay shoes because of a foot deformity, and 2 additional pairs of inserts

In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.

Most importantly, Medicare will only cover your therapeutic shoes if the prescribing doctor or supplier is enrolled in Medicare.

Alternate Footwear Every Day

While Medicare only covers 1 pair of depth-inlay shoes per year, it is always a good idea to alternate the shoes you wear, so that you are not wearing the same shoes every day. This will allow your shoes to dry out and will help them last longer. And it will ensure your shoes continue to provide adequate protection for your feet.

Therefore, you may want to purchase an additional pair of shoes that are approved for diabetic use. There may be specialty shoe stores in your area that sell therapeutic shoes. In addition, you may be able to find them online. Just look for styles that say they are A5500-approved or include the symbol below. This symbol indicates these shoes have been specifically approved for use by diabetics.

If you do purchase another pair of depth-inlay or A5500-approved shoes on your own, please keep in mind these shoes are not eligible for Medicare coverage. However, they are well worth the investment, especially when it comes to caring for and protecting your diabetic feet.

 

Here’s a link to another great resource you may find helpful. Medicare’s Coverage of Diabetes Supplies & Services.