Medicare is a federal health insurance program for people 65 and older, people with certain disabilities. If you have diabetes and foot complications, understanding your Medicare coverage for diabetic shoes can save you money and protect your health.
Medicare covers a wide range of services for people with diabetes, including:
If you have diabetes, you may be eligible for Medicare coverage for diabetic shoes.
According to Medicare.gov, Medicare Part B (Medical Insurance) covers the furnishing and fitting of either of these each calendar year, if you have diabetes and severe diabetic foot disease:
To be eligible for diabetic shoes Medicare coverage, you must have at least one of six specific conditions documented by a qualified doctor. These following conditions include:
The documentation requirements for Medicare diabetic shoes are specific and must be completed properly for Medicare to pay your claim.
The doctor treating your diabetes must certify that you meet the qualifying conditions. This certification proves you're under a comprehensive diabetes care plan.
A qualified doctor (typically your primary care physician or endocrinologist) must certify that you meet specific conditions, while your podiatrist or foot doctor must complete a detailed foot examination documenting the following conditions.
The certification must be signed within three months before you receive your shoes and renewed annually to maintain Medicare coverage for new shoes each calendar year.
Also according to Medicare.gov, Medicare pays only when both doctors and suppliers meet strict standards and stay 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.
If you are unsure whether or not your shoes are covered, you can contact your local Medicare office.
Understanding your options helps you get the right therapeutic shoes for your needs.
Extra depth shoes provide 3/16" to 1/2" additional depth throughout the shoe. They accommodate pressure-relieving inserts and minor foot deformity. Medicare covers one pair of extra depth shoes annually with three pairs of inserts. These work well for many patients with diabetic neuropathy and callus formation.
No. 77 Women's Sport Double Depth
Shoe modifications can substitute for separate inserts when needed. Both types must be Medicare approved and manufactured to accommodate durable medical equipment standards.
Medicare Part B covers 80% of the Medicare approved amount after you meet your B deductible. You pay 20% coinsurance if your supplier accepts an assignment.
For 2025, typical Medicare reimbursement for extra depth shoes with three pairs of inserts ranges from $385-$395. Your cost would be approximately $60-$80 for the 20% payment amount.
If your supplier doesn't accept assignments, there's no limit on what they can charge you. This could significantly increase your out-of-pocket cost. Always verify that your supplier accepts assignments before placing your order.
Medicare Advantage plans must provide at least the same coverage as Original Medicare. Some plans may offer additional benefits that reduce your cost.
Medicaid secondary coverage may pay your remaining cost if you're dually eligible. Contact your provider to understand your complete payment responsibility.
Medicare uses specific HCPCS codes for diabetic shoes billing.
A5500 is the code for off-the-shelf extra depth shoes with multi-density inserts. Your supplier submits the claim using these codes along with required documentation from your doctor.
Medicare won't pay the claims if suppliers aren't enrolled and don't meet strict standards. The supplier must include the page of documentation showing your certification and prescription with each claim submission.
Your provider should give you a detailed note explaining what Medicare covers and what you'll pay. Keep this documentation for your records.
You must get your shoes and inserts from a qualified individual enrolled in Medicare. Approved providers include:
According to Medicare.gov, Medicare will only cover your therapeutic shoes if your doctors and suppliers are enrolled in Medicare. Verify enrollment status before your appointment.
If you are unsure whether or not your shoes are covered, you can contact your local Medicare office.Here are some additional resources for people with diabetes and Medicare:
The statistics show why Medicare diabetic shoes represent a critical health intervention, not just a comfort issue.
Proper diabetic shoes can reduce amputation risk by up to 85%. The five-year mortality rate for patients with diabetic foot ulcers ranges from 30-68%. These numbers highlight the serious nature of diabetic foot complications.
Anodyne No. 35 Women's Sport Move
Therapeutic shoes help protect the insensitive foot from unnoticed trauma and excessive plantar pressures. Professional foot care and therapeutic shoes have helped reduce lower limb amputation rates among Medicare beneficiaries.
The National Institute of Diabetes and Digestive and Kidney Diseases emphasizes that preventive foot care, including proper footwear, is essential for everyone with diabetes.
At Anodyne, we understand the importance of combining medical necessity with comfort and quality. Our collection of therapeutic shoes is designed to meet your specific health needs while supporting your daily activities. Explore our range of diabetic shoes and find helpful resources on proper foot care, fitting guidelines, and more. Your foot health matters, and we're here to support your journey every step of the way.
Yes, Medicare coverage for diabetic shoes resets each calendar year. You're eligible for one pair of shoes and three pairs of inserts annually if you continue meeting certain criteria. The annual benefit ensures you have proper footwear as your foot condition changes.
Medicare approved shoes must meet strict standards including removable fillers providing minimum 3/16" additional depth, quality materials, proper closure, and availability in multiple sizes and widths. Regular diabetic shoes may not meet these specific guidelines required for Medicare reimbursement.
If your supplier doesn't accept assignment, Medicare reimbursement rules don't limit what they can charge. You could pay significantly more than the 20% coinsurance. Always verify accept assignment status before ordering.
Yes, the doctor treating your diabetes must certify your need, and a podiatrist or other qualified doctor must prescribe the shoes or inserts. Both pieces of documentation are required for Medicare to process your claim.
Medicare only covers one pair per calendar year. Additional shoes would be out-of-pocket unless you have supplemental insurance that provides extra benefits. Some patients purchase a second pair at their own cost for backup.