Qualifying Medicare Patients for Therapeutic Shoes

For someone diagnosed with diabetes mellitus, Medicare may cover the cost of therapeutic shoes and custom inserts; however, specific criteria must be met in a face-to-face exam. First, only a Medical Doctor (MD) or a Doctor of Osteopathy (DO) can order diabetic-friendly footwear and inserts. If the face-to-face is completed by a Podiatrist, Physician’s Assistant (PA-C) or Nurse Practitioner (APRN/NP), then there must be a physician who agrees with the foot exam and plan for shoes/inserts. 

The physician must certify that the patient has diabetes and is under a comprehensive plan of care for his/her diabetes. It must also document that the patient suffers from one or more of the following conditions (the more specific the better): 

  • Amputation of the foot or part of the foot
  • History of previous foot ulceration of either foot
  • History of pre-ulcerative calluses of either foot
  • Peripheral neuropathy with evidence of callus formation of either foot
  • Foot deformity of either foot
  • Poor circulation of either foot

Medicare will cover the cost of the therapeutic shoes and inserts if all of the criteria is met. They will cover one new pair of therapeutic shoes per calendar year, along with three pairs of custom inserts

HCPCS To Know

A5500 Therapeutic Shoes

A5514 Insert (Camera-Tech Molded)

A5513 Insert (Foot-Contact Molded)

A5512 Insert (Heat Moldable)

Written by:

Joselin Lockard, RRT

Frontier Home Medical Sales Representative

(Kearney, Grand Island, Lincoln)

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