Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Diabetic Shoes & Custom Orthotics: Medicare Coverage, Benefits & How to Get Them

One of the most underutilized benefits in Medicare is the Therapeutic Shoe Bill (TSB) — providing diabetic patients with covered therapeutic footwear that can prevent foot ulcers, hospitalizations, and amputations. At Balance Foot & Ankle, we are a certified provider of diabetic footwear and help hundreds of patients access this benefit each year.

Why Diabetic Patients Need Specialized Footwear

Diabetes creates foot problems through two main pathways:

• Neuropathy (nerve damage): Loss of protective sensation means patients can’t feel pressure, friction, or injuries. Regular shoes create pressure points that a neuropathic patient can’t feel — leading to ulcers that may go unnoticed until serious.
• Poor circulation (peripheral arterial disease): Reduced blood flow means even small wounds heal poorly and are vulnerable to infection.

Properly fitted diabetic shoes and custom inserts dramatically reduce these risks by offloading pressure points, accommodating deformities, and providing protective cushioning.

Medicare Coverage: The Therapeutic Shoe Bill

Medicare Part B covers therapeutic footwear for Medicare beneficiaries with diabetes. Coverage includes:

• One pair of therapeutic (extra-depth) shoes per calendar year
• Three pairs of inserts per calendar year (or two pairs of custom molded inserts plus one pair of extra-depth shoes)
• Coverage rate: Medicare pays 80% of the approved amount; the remaining 20% may be covered by secondary insurance

Who Qualifies?

To qualify for the Medicare Therapeutic Shoe Program, you must:

1. Have Medicare Part B
2. Have a diabetes diagnosis with ANY of the following conditions:
   • Peripheral neuropathy with callus formation
   • History of pre-ulcerative calluses
   • History of previous foot ulceration
   • Foot deformity (bunions, hammertoes, flat feet, Charcot foot)
   • Previous amputation of the foot or part of the foot
   • Poor circulation (peripheral vascular disease)
3. Have your prescribing physician (primary care or endocrinologist) certify the need and sign the documentation

The Process at Balance Foot & Ankle

1. Evaluation: We perform a comprehensive diabetic foot exam to document your qualifying conditions
2. Prescribing physician coordination: Your primary care doctor or endocrinologist must certify the medical necessity; we provide the documentation
3. Fitting: We measure your feet and fit you for therapeutic shoes with the right extra depth, width, and features for your specific deformities
4. Custom inserts: We take foot impressions or use our 3D foot scanner to fabricate custom molded inserts that accommodate your specific pressure pattern and deformities
5. Delivery and fitting: We ensure proper fit and educate you on daily wear, skin inspection, and care

What Makes Diabetic Shoes Different?

• Extra depth: 3/8″ to 1/2″ additional depth accommodates custom inserts and foot deformities without creating pressure points
• Wide toe box: Accommodates hammertoes, bunions, and swelling without compression
• Seamless or minimal-seam interior: Reduces friction against neuropathic skin
• Firm heel counter: Provides stability and reduces excessive hindfoot motion
• Non-slip sole: Reduces fall risk
• Straps or laces: Adjustable closure for variable swelling

Why Custom Inserts vs. OTC Insoles?

Custom molded inserts (HCPCS L3000 series) are fabricated from a positive model of your foot — they exactly match your foot’s shape and can be modified to offload specific pressure areas. Research shows that diabetic patients fitted with custom inserts have significantly fewer foot ulcers than those with OTC insoles. For patients with previous ulcers or Charcot deformity, custom total contact inserts are especially important.

Clinical Evidence: Does Diabetic Footwear Work?

Multiple studies confirm that therapeutic diabetic footwear reduces foot ulcer incidence by 50–85% in high-risk patients. Given that diabetic foot ulcers are the leading cause of non-traumatic lower limb amputations, and that each amputation costs the healthcare system $50,000–$100,000+, this benefit has enormous clinical and economic value.

Other Insurance Plans

Beyond Medicare, many commercial plans cover diabetic footwear with varying criteria. Medicaid (Michigan) covers diabetic shoes for qualifying patients. Many Advantage plans cover the benefit at the Medicare rate. Call us — we verify benefits before ordering your shoes so there are no surprises.

Ready to Get Relief? We’re Here to Help.

Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

📅 Book Online
📞 (810) 206-1402

Related Conditions

• Diabetic Foot Care Guide
• Neuropathy Treatment
• Custom Orthotics

Get Diabetic Shoes & Orthotics Covered by Medicare

Medicare covers therapeutic shoes and custom orthotics for qualifying diabetic patients. Our podiatrists handle the prescription and fitting process to ensure you get the coverage you deserve.

Learn About Insurance Coverage | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Medicare.gov. Therapeutic shoes or inserts. Medicare.gov Benefits. 2024.
2. Lavery LA, et al. Effectiveness of therapeutic footwear in reducing diabetic foot ulcer recurrence. Diabetes Care. 2012;35(7):1580-1585.
3. Bus SA, et al. Footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes. Diabetes Metab Res Rev. 2016;32(S1):99-118.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

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.