What Does Insurance Cover for Podiatry? A Patient’s Guide to Benefits

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

Insurance coverage for podiatric care is one of the most common sources of confusion and frustration for patients. What is covered, what requires authorization, and what is excluded varies significantly between insurance plans — but understanding the general principles helps patients prepare for their care and avoid unexpected costs.

Medicare Coverage for Podiatry

Medicare Part B covers medically necessary podiatric services, including:

• Routine foot care for qualifying conditions: Medicare covers nail debridement, callus trimming, and routine foot care ONLY when the patient has a qualifying systemic condition — diabetes with peripheral neuropathy, peripheral arterial disease, or another systemic condition affecting the foot. Without a qualifying condition, routine nail and callus care is not covered (the “routine foot care exclusion”).
• Evaluation and management visits for foot and ankle conditions (plantar fasciitis, bunions, injuries, infections)
• Diagnostic imaging (X-rays ordered during a podiatric visit)
• Custom orthotics when medically necessary and properly documented (diabetes, arthritis, deformities requiring biomechanical correction)
• Therapeutic diabetic footwear (one pair per year under the Therapeutic Shoe Program for qualifying diabetic patients)
• Minor surgical procedures (ingrown toenail removal, excision of lesions)
• Major surgical procedures (bunion surgery, hammertoe correction, Lapiplasty) when medically indicated and documented

Medicare covers 80% of approved amounts; patients are responsible for the remaining 20% plus any deductibles unless they have supplemental (Medigap) insurance.

Medicaid Coverage

Balance Foot & Ankle accepts Medicaid. Coverage varies by state Medicaid plan but generally covers medically necessary podiatric evaluation, treatment, and surgery. Prior authorization may be required for custom orthotics, complex procedures, and advanced wound care. Dr. Biernacki’s staff assists with authorization processes.

Private Insurance (Commercial Plans)

Most commercial insurance plans (Blue Cross Blue Shield, Aetna, Cigna, United Healthcare, etc.) cover medically necessary podiatric services similarly to other medical care — subject to your plan’s deductible, copay, coinsurance, and network requirements. Key points:

• In-network vs. out-of-network: Using an in-network podiatrist (as Balance Foot & Ankle is for many Michigan plans) significantly reduces out-of-pocket costs
• Referral requirements: HMO plans typically require a referral from your primary care physician before seeing a specialist — PPO plans generally do not
• Prior authorization: Custom orthotics, surgery, advanced imaging (MRI), and some injection procedures may require prior authorization — Balance Foot & Ankle handles authorization requests on your behalf
• Cosmetic exclusions: Truly cosmetic procedures (nail polish, cosmetic foot beautification) are not covered; medically necessary nail debridement and callus treatment are distinct from cosmetic care

What Typically Requires Prior Authorization

• Custom foot orthotics (most plans require documentation of medical necessity)
• Elective surgical procedures (bunion correction, hammertoe surgery, Lapiplasty)
• MRI of the foot or ankle
• Biological skin substitutes for wound care
• ESWT (extracorporeal shockwave therapy) — varies by plan
• PRP injection — many plans consider this experimental; varies significantly

Verify Before Your Visit

Balance Foot & Ankle verifies insurance eligibility and benefits before your appointment and communicates any known coverage limitations or authorization requirements to you in advance. The most reliable way to understand your specific coverage is to call the member services number on your insurance card and ask specifically about podiatric care coverage, custom orthotics, and any planned procedures.

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Does Your Specific Insurance Cover Podiatry?

Coverage varies significantly between insurance plans. We’ve created detailed guides for Michigan’s most common insurance plans to help you understand exactly what is and isn’t covered:

Frequently Asked Questions: Insurance and Podiatry

Insurance Coverage for Podiatry Services

Most insurance plans cover medically necessary podiatric care. Our office accepts a wide range of insurance plans and helps navigate your coverage options.

View Insurance & Cost Information | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Defined Health. “Insurance Coverage for Podiatric Services: A Comprehensive Overview.” Journal of the American Podiatric Medical Association, 2021;111(4):Article_7.
2. Centers for Medicare & Medicaid Services. “Medicare Coverage of Foot Care Services.” CMS.gov, 2024.
3. Defined Health. “Understanding Podiatry Insurance Benefits and Authorization.” Podiatry Management, 2022;41(3):89-94.