Medically Reviewed by Dr. Jeffery Agnoli, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
The Medicare Therapeutic Shoe Bill (Section 4072 of the Omnibus Budget Reconciliation Act of 1987) established coverage for therapeutic footwear for diabetic Medicare beneficiaries as a preventive benefit — recognizing that appropriate footwear reduces the incidence of diabetic foot ulcers and amputations, the most costly complications of diabetes. Understanding the coverage criteria, documentation requirements, and fitting process helps diabetic patients access this underutilized benefit and helps providers ensure compliance with Medicare billing requirements.
Coverage Criteria and Eligible Beneficiaries
Medicare Part B covers diabetic shoes under the diabetic shoe program (HCPCS codes A5500–A5513) when the patient meets ALL of the following criteria: diagnosis of diabetes mellitus (ICD-10 E10-E14); documentation of at least one of the following diabetic foot conditions: previous foot amputation, previous foot ulceration, peripheral neuropathy with evidence of callus formation, poor circulation, foot deformity, or previous pre-ulcerative callus. The treating physician (most commonly the patient’s primary care physician or endocrinologist) must certify medical necessity by completing and signing the physician certification statement before the shoes are dispensed. The podiatrist or certified pedorthist fits and dispenses the footwear but cannot certify medical necessity for their own patients (except in states that have received exceptions).
Coverage Details and Annual Benefit
Annual Medicare coverage: one pair of therapeutic shoes (A5500) or one pair of depth-inlay shoes (A5500) OR one pair of custom-molded shoes (A5501 — for patients with severe foot deformity who cannot be fitted with depth-inlay shoes) AND three pairs of extra-depth inserts (A5512) or custom-molded inserts (A5513). Patient cost-sharing: 20% coinsurance after Part B deductible is met. Documentation requirements: a complete qualifying evaluation including documentation of the specific qualifying condition, ABI or vascular assessment if circulation is a concern, and footwear prescription with specific shoe modifications (if applicable). Fitting considerations: extra-depth shoes provide 3/16″ additional depth to accommodate custom orthotics and toe deformities; rocker-bottom modification reduces forefoot pressure by 20–30%; hallux valgus last accommodates bunion deformity. Dr. Biernacki at Balance Foot & Ankle certifies and fits Medicare diabetic shoes and inserts for eligible patients at both our Bloomfield Hills and Howell offices. Call (810) 206-1402 to determine your eligibility.
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Frequently Asked Questions
How often should diabetics have their feet checked by a podiatrist?
People with diabetes should have a comprehensive 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 Township offices.
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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.
Frequently Asked Questions
Can a podiatrist help with neuropathy?
What does neuropathy in feet feel like?
Is foot neuropathy reversible?
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)
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