Diabetic Footwear and Medicare Therapeutic Shoe Coverage: What Qualifies and How to Get Fitted

Medicare’s Therapeutic Shoe Program (Medicare Part B, HCPCS codes A5500–A5513) covers one pair of custom-molded or depth-inlay shoes and three pairs of custom inserts per calendar year for qualifying diabetic patients — significantly reducing the out-of-pocket cost of medically necessary footwear that can prevent diabetic foot ulcers, amputations, and hospitalizations. Understanding the qualification criteria and the fitting process helps patients access this coverage.

Medicare Qualification Criteria

To qualify for Medicare therapeutic shoe coverage, the patient must: (1) have diabetes (covered under the diabetes diagnosis); (2) have at least one of the following conditions: previous foot amputation; previous foot ulceration; peripheral neuropathy with callus formation; poor circulation (peripheral arterial disease); foot deformity (bunion, hammertoe, Charcot foot); or prior pre-ulcerative callus. The certifying physician (the treating physician managing the patient’s diabetes — typically the primary care physician or endocrinologist) must certify that comprehensive diabetic foot care is being provided and that therapeutic footwear is medically necessary. The podiatrist or certified pedorthist prescribes and fits the shoes and inserts.

Types of Covered Footwear and Fitting Process

Extra-depth shoes (A5500): pre-manufactured shoes with a deeper toe box and removable inserts — the most common covered shoe type. Custom-molded shoes (A5501): fabricated from a plaster or digital cast of the patient’s foot — indicated for severe deformity (Charcot foot, prior amputation) that cannot be accommodated in standard extra-depth shoes. Custom inserts (A5513): accommodative inserts with total contact molding that redistribute plantar pressure away from high-risk areas. The fitting process: a thorough foot examination identifies pressure areas, deformities, and functional requirements; shoe selection and insert prescription are based on the examination findings; a final fitting confirms appropriate fit with no pressure points. Dr. Biernacki at Balance Foot & Ankle provides Medicare therapeutic shoe prescription and fitting as part of comprehensive diabetic foot care. Qualifying patients can receive Medicare-covered footwear each calendar year. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your diabetic foot concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Frequently Asked Questions

How often should diabetics have their feet checked by a podiatrist?

People with diabetes should have a thorough foot examination by a podiatrist at least once per year, and more frequently (every 1–3 months) if they have neuropathy, poor circulation, history of foot ulcers, or active foot problems.

What is the biggest foot danger for diabetics?

Loss of protective sensation (neuropathy) combined with poor circulation creates a dangerous combination — minor injuries can go unnoticed and become infected. Foot ulcers affect 15–25% of diabetics over their lifetime and are the leading cause of non-traumatic amputations.

Does Medicare cover diabetic foot care?

Yes. Medicare covers annual diabetic foot exams for patients with peripheral neuropathy, as well as therapeutic shoes and inserts under the Diabetic Shoe Bill. Balance Foot & Ankle accepts Medicare.

Need Treatment at Balance Foot & Ankle?

Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Hills offices.

Book Online or call (810) 206-1402

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Diabetic Neuropathy and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Tarsal tunnel syndrome. Burning radiating into the arch with positive Tinel’s at the medial ankle.
• Peripheral artery disease. Pain with walking that resolves with rest, weak pulses, hair loss on toes.
• Lumbar radiculopathy. Symptoms following a dermatome, often with back pain — MRI of spine, not foot.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stopping B-vitamin supplementation as soon as symptoms improve. Fix: maintain supplementation for 6-18 months alongside strict glucose control.

Warning Signs That Need Same-Day Care

Frequently Asked Questions

When should I see a podiatrist?

If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).

What does treatment cost?

Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.

How quickly can I get an appointment?

Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.