Case Flash: Medicare Coverage Of Therapeutic Shoes For Diabetes

Mrs. C has Original Medicare Parts A and B. She has Type I Diabetes and has had a lot of trouble stabilizing her blood sugar levels over the past few years. At her last appointment, Mrs. C’s primary care physician found that Mrs. C’s feet were starting to feel numb. He tested her circulation and found out that it was poor. The physician recommended that Mrs. C see a podiatrist for advice on how to prevent future complications. When Mrs. C went to the podiatrist, he fit her for a pair of custom-molded diabetic shoes. She paid a 20 percent coinsurance and picked up the shoes the following week.

When Mrs. C received her Medicare Summary Notice (MSN) the next month, it showed that Medicare had paid for her visit to the podiatrist, but denied payment for the expensive custom-molded shoes. Mrs. C called the podiatrist’s office and found out that they had received a denial from Medicare, stating that Mrs. C was not eligible for Medicare coverage of diabetic shoes.

Mrs. C called the Medicare Rights Center and spoke to a hotline counselor. The counselor explained to Mrs. C that Medicare does in fact cover custom-molded shoes, depth shoes and inserts for people with severe diabetic foot diseases, including poor circulation. However, in order for Medicare to cover diabetic shoes, the prescribing doctor needs to provide evidence that the patient has one of these severe conditions. While Mrs. C’s primary care physician had done the tests and found that Mrs. C had poor circulation, the prescribing doctor (the podiatrist) needed to give Medicare the results of those tests in order for the shoes to be covered. The hotline counselor suggested that Mrs. C call the podiatrist’s office and ask them to request copies of the medical records and test results from her primary care physician. She was advised to ask the podiatrist’s office to resubmit the claim for the shoes to Medicare, along with a copy of the physician’s records and test results.

Mrs. C called the podiatrist’s office again and the assistant agreed to call Mrs. C’s physician’s office and ask for the test results and records. Mrs. C’s physician gladly faxed the documents to the podiatrist’s office, and the podiatrist’s office sent the claim back to Medicare with the additional medical evidence. Once Medicare received all of the necessary information, Medicare paid the remaining 80 percent for the cost of the shoes.

-From:  “Case Flash: Medicare Coverage Of Therapuetic (sic) Shoes For Diabetes ”, Medicare Watch, a biweekly electronic newsletter of the Medicare Rights Center, Vol. 11 , No. 16 : August 5, 2008.

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