Medicare Diabetic Shoe Program: Getting Custom Footwear Covered for Diabetes Foot Protection

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

Medically reviewed by Dr. Thomas Biernacki, DPM, FACFAS — Board-certified podiatric physician and Medicare Therapeutic Shoe Program provider at Balance Foot & Ankle, Southeast Michigan.

Quick Answer: Medicare covers one pair of therapeutic shoes and three pairs of custom inserts per calendar year for qualifying diabetic patients through the Therapeutic Shoe Program (also called the Diabetic Shoe Bill). You qualify if you have diabetes, Medicare Part B, and at least one qualifying foot condition (neuropathy, prior ulcer, foot deformity, poor circulation, prior amputation, or calluses). Your treating physician certifies need, and a podiatrist prescribes and fits the footwear. Out-of-pocket cost is typically $0–$50 after Medicare pays 80% and secondary insurance covers the remaining 20%.

In This Guide

Affiliate disclosure: This page contains affiliate links to supplemental products we recommend alongside Medicare-covered diabetic footwear. We may earn a small commission at no extra cost to you. All recommendations are based on clinical experience at Balance Foot & Ankle.

If you have diabetes and Medicare, you may be eligible for custom-fitted therapeutic shoes and inserts at little or no cost — yet an estimated 85% of qualifying patients never take advantage of this benefit. The Medicare Therapeutic Shoe Program exists because proper footwear is one of the most effective tools for preventing the diabetic foot ulcers that lead to infection, hospitalization, and amputation. Understanding the program, the qualification process, and how to maximize your coverage can protect your feet and save you significant out-of-pocket costs.

What Is the Medicare Diabetic Shoe Program?

The Medicare Therapeutic Shoe Program (formally known as the Therapeutic Shoe Bill, passed in 1993) is a Medicare Part B benefit that covers custom-molded or depth shoes, custom inserts, and shoe modifications for people with diabetes who are at risk for foot complications. The program recognizes that proper footwear is a medical necessity — not a luxury — for diabetic patients with foot conditions that place them at risk for skin breakdown and ulceration.

Medicare Part B pays 80% of the approved amount for therapeutic shoes and inserts. If you have a Medicare supplement (Medigap) policy, it typically covers the remaining 20% coinsurance. Patients with both Medicare and Medicaid (dual-eligible) usually pay nothing out of pocket. For patients with Medicare alone and no supplement, the typical copay ranges from $25–$50 for shoes and $15–$30 for inserts.

Why Diabetic Footwear Matters

The clinical evidence supporting therapeutic footwear for diabetes is compelling:

• Ulcer prevention — Properly fitted therapeutic shoes with custom inserts reduce peak plantar pressure by 30–50% compared to standard footwear, directly reducing ulceration risk at vulnerable pressure points.
• Ulcer recurrence reduction — Studies show that patients who wear therapeutic footwear consistently have a 50–60% lower rate of ulcer recurrence compared to those in standard shoes.
• Amputation prevention — Diabetic foot ulcers precede 85% of diabetes-related amputations. By preventing ulcers, therapeutic footwear addresses the root cause of the amputation cascade.
• Cost-effectiveness — The cost of a pair of therapeutic shoes ($300–$500) is a fraction of treating a single diabetic foot ulcer ($8,000–$17,000) or performing an amputation ($40,000–$100,000+).
• Fall prevention — Neuropathic patients have impaired balance and proprioception. Therapeutic shoes with firm soles and structured support reduce fall risk in this vulnerable population.

Who Qualifies?

To qualify for the Medicare Therapeutic Shoe Program, you must meet all three of the following criteria:

1. Diabetes diagnosis — Type 1 or Type 2 diabetes documented in your medical record, managed by a physician (MD or DO), physician assistant, or nurse practitioner.
2. Medicare Part B enrollment — You must have active Medicare Part B coverage. Medicare Advantage plans (Part C) also cover therapeutic shoes, though the process may differ slightly by plan.
3. At least one qualifying foot condition — Your treating physician must certify that you have one or more of the specific foot conditions listed in the qualifying conditions section below.

Qualifying Foot Conditions

Medicare requires that your treating physician (the doctor managing your diabetes, not your podiatrist) certify that you have at least one of the following foot conditions:

• Peripheral neuropathy with evidence of callus formation — Loss of protective sensation combined with pressure-related calluses that indicate ulcer risk
• History of pre-ulcerative calluses — Calluses with hemorrhage (bleeding) beneath them, indicating tissue damage from excessive pressure
• History of previous foot ulceration — Any prior diabetic foot ulcer, regardless of whether it healed
• Foot deformity — Hammertoes, bunions, Charcot foot, prominent metatarsal heads, or any structural abnormality that concentrates pressure
• Previous amputation of the foot or part of the foot — Partial foot amputation changes weight-bearing mechanics and requires specialized footwear accommodation
• Poor circulation — Peripheral arterial disease documented by clinical examination, ankle-brachial index, or vascular studies

What Is Covered?

Each calendar year, Medicare covers the following therapeutic shoe benefit:

Option A (most common): One pair of depth shoes (extra-depth construction that accommodates custom inserts and foot deformities) PLUS three pairs of custom-molded inserts. The inserts are replaced every 4 months to maintain proper pressure redistribution as they wear.

Option B: One pair of custom-molded shoes (individually manufactured from a cast or model of the patient’s foot) PLUS two pairs of custom inserts. Custom-molded shoes are reserved for patients whose foot deformity is too severe for standard depth shoes (typically Charcot foot, major amputation, or severe combined deformities).

Shoe modifications are also covered when needed, including rocker soles, metatarsal bars, wedges, and other modifications that alter the shoe’s biomechanical properties to reduce pressure at specific sites.

The Step-by-Step Process

Getting your Medicare diabetic shoes requires coordination between your treating physician and your podiatrist. Here is the complete process from start to finish:

1. Physician certification — Your treating physician (the doctor managing your diabetes) completes a Statement of Certifying Physician form documenting your diabetes diagnosis and qualifying foot condition. This must be signed within 6 months prior to delivery of the shoes.
2. Podiatrist prescription — Your podiatrist performs a comprehensive foot evaluation, determines the appropriate shoe type and insert specifications, and writes the prescription. The podiatrist cannot be the same physician who certified you (with limited exceptions).
3. Fitting appointment — You visit the podiatrist or certified pedorthist for measurements, foam impressions (for custom inserts), and shoe selection. Most offices have therapeutic shoe samples to try on for style and fit preference.
4. Fabrication — Custom inserts are fabricated from your foam impressions, typically taking 1–2 weeks. Shoes may be available from stock or ordered, usually arriving within 1–3 weeks.
5. Delivery and final fitting — You return to verify the fit of both shoes and inserts. The provider checks that the shoes accommodate your foot deformities, the inserts distribute pressure appropriately, and you can put them on and take them off independently.
6. Documentation and billing — The provider submits claims to Medicare with all required documentation. You pay your 20% coinsurance (or nothing if you have a supplement that covers it).

Physician Certification Requirements

The physician certification is the most common point of failure in the therapeutic shoe process — many qualifying patients miss out because their primary care physician is unfamiliar with the form or the program. Here is what the certifying physician needs to know:

• The certifying physician must be the doctor managing the patient’s diabetes (typically their primary care physician or endocrinologist)
• The certification form (CMS-DME Form) documents the diabetes diagnosis and at least one qualifying foot condition
• The certifying physician must have examined the patient within the 6 months prior to shoe delivery
• The certification must be completed BEFORE the shoes are dispensed — retroactive certification is not accepted
• The certifying physician and the prescribing podiatrist must generally be different providers (anti-referral rules apply)

At Balance Foot & Ankle, we streamline this process by faxing the certification form directly to your physician’s office with clear instructions. Most certifications are completed within 1–2 business days.

The Fitting Appointment

The fitting appointment is where the science of biomechanical pressure redistribution meets the practical reality of finding shoes you will actually wear every day. During this visit, your podiatrist or certified pedorthist will:

• Measure both feet while standing (weight-bearing) for length, width, and depth
• Evaluate foot deformities that require specific shoe features (extra depth, wide toe box, rocker sole)
• Take foam impressions of both feet for custom insert fabrication — you stand in specialized foam boxes that capture the exact contour of your plantar surface
• Discuss shoe style preferences — therapeutic shoes now come in athletic, casual, dress, and work boot styles that look like regular shoes
• Assess gait pattern to determine whether shoe modifications (rocker sole, metatarsal bar) would benefit your walking mechanics

Features of Therapeutic Diabetic Shoes

Therapeutic diabetic shoes differ from standard footwear in several critical ways designed to protect neuropathic feet:

• Extra depth — 1/4 to 1/2 inch deeper than standard shoes to accommodate custom inserts and foot deformities (hammertoes, bunions) without creating pressure points on the dorsum
• Wide toe box — Generous forefoot width prevents lateral compression on toes that cannot feel pressure, reducing the risk of ulceration between toes and on bony prominences
• Seamless or minimal-seam interior — Internal seams are eliminated or flattened to prevent friction points that neuropathic patients cannot detect
• Firm heel counter — Structured heel cup that stabilizes the calcaneus and prevents excessive pronation or supination during walking
• Removable insole — Designed to be replaced with custom-molded inserts that precisely redistribute plantar pressure away from vulnerable areas
• Rocker sole (when prescribed) — A curved sole profile that reduces forefoot pressure during push-off by transferring load to the midfoot, reducing metatarsal head pressure by 20–40%
• Velcro or elastic closures — Adjustable fit that accommodates the fluctuating foot swelling common in diabetic patients, and easier donning/doffing for patients with limited hand dexterity

Custom Inserts vs. Stock Insoles

The custom inserts covered by Medicare are fabricated from your individual foot impressions and specifically designed to redistribute pressure away from your high-risk areas. They differ significantly from over-the-counter insoles:

• Custom contour — Molded to your exact foot shape, including arch height, metatarsal head positions, and any deformity accommodation
• Multi-density construction — Softer materials beneath high-pressure zones (metatarsal heads, heel) and firmer materials in supportive zones (arch, midfoot)
• Accommodative features — Cutouts or depressions beneath bony prominences, prior ulcer sites, or callus-prone areas to eliminate focal pressure
• Three pairs per year — Medicare provides three sets because the cushioning materials compress over time (approximately 4 months) and lose their pressure-redistributing properties

Between custom insert replacements, or for shoes where custom inserts are not practical (casual shoes, around-the-house footwear), a high-quality over-the-counter insole provides better support than no insole at all.

Supplemental Products That Enhance Your Medicare Footwear

Doctor Hoy’s Natural Pain Relief Gel — Neuropathic Comfort

Diabetic neuropathy creates burning, tingling, and aching that makes wearing shoes uncomfortable. Doctor Hoy’s Natural Pain Relief Gel uses clean, plant-based ingredients — including arnica and menthol — to provide cooling relief without the harsh chemicals that can irritate diabetic skin. The natural formula is particularly important for patients with compromised skin integrity, where synthetic topicals may cause reactions. Apply before inserting feet into therapeutic shoes for enhanced all-day comfort.

DASS Compression Socks — Diabetic-Safe Circulation Support

Edema is one of the most common reasons Medicare shoes feel uncomfortable by afternoon. DASS graduated compression socks use gentle 15–20 mmHg pressure to reduce swelling and improve venous return without restricting arterial blood flow. For diabetic patients, maintaining consistent foot volume throughout the day means your therapeutic shoes fit properly from morning to evening. The moisture-wicking fabric also reduces friction — a critical factor in blister and ulcer prevention.

PowerStep Maxx Insoles — For Severe Deformity and High-Risk Feet

Patients with Charcot foot, significant bunion deformity, or prior partial amputation need maximum stability beyond what standard Medicare inserts provide. PowerStep Maxx insoles feature an encapsulated shell design with dual-layer cushioning and enhanced motion control. The firmer arch and deep heel cup stabilize deformed feet during the months between Medicare fittings when your custom inserts may begin to compress. These are particularly valuable for patients whose deformity has progressed since their last Medicare fitting.

Most Common Mistake With the Medicare Shoe Program

Warning Signs That Require Immediate Medical Attention

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.

Related Diabetic Foot Treatments at Balance Foot & Ankle

The Medicare Therapeutic Shoe Program is one component of comprehensive diabetic foot care. Our clinic provides the full spectrum of treatments that protect diabetic feet from complications:

• Diabetic Foot Care Program — comprehensive annual exams, risk stratification, and preventive care plans
• Advanced Wound Care — evidence-based treatment for diabetic ulcers including debridement, offloading, and biologics
• Custom Orthotics — prescription devices for patients needing support beyond Medicare insert coverage
• Peripheral Neuropathy Treatment — managing the nerve damage that makes protective footwear essential
• Charcot Foot Management — specialized care for this devastating diabetic complication

Frequently Asked Questions About the Medicare Diabetic Shoe Program

How much does the Medicare therapeutic shoe program cost me out of pocket?

Under Original Medicare Part B, you pay 20% of the Medicare-approved amount after meeting your annual Part B deductible. For most patients, this means approximately $0–50 out of pocket for one pair of therapeutic shoes and three pairs of custom inserts per calendar year. Many Medicare Advantage plans cover the full cost with no copay. Your DME supplier can verify your specific plan’s coverage before your fitting appointment.

Can I choose any shoes I want through the Medicare program?

No — shoes must meet specific therapeutic criteria established by Medicare. They must be extra-depth construction (at least 5/16 inch deeper than standard shoes), have a wide toe box, seamless interior lining, firm heel counter, and removable insole to accommodate custom inserts. Your certified pedorthist or podiatrist will present options that meet all requirements while still offering choices in style, color, and closure type. Athletic, dress, and casual styles are available from approved therapeutic shoe manufacturers.

How often can I get new shoes and inserts through Medicare?

Medicare covers one pair of therapeutic shoes and three pairs of custom-molded inserts (or three pairs of inserts plus shoe modifications) per calendar year. The benefit resets every January 1st. You need a new physician certification statement each year confirming you still have diabetes and a qualifying condition. Many patients schedule their annual fitting in January to maximize the benefit period. If your foot condition changes significantly mid-year, additional modifications may be covered with proper documentation.

Do I need a referral from my primary care doctor?

Yes — Medicare requires a certification statement from the physician managing your diabetes. This is typically your primary care doctor, endocrinologist, or internal medicine specialist. The certifying physician must document your diabetes diagnosis and confirm you have at least one qualifying condition (peripheral neuropathy with callus formation, history of pre-ulcerative callus, history of previous ulceration, foot deformity, previous amputation, or poor circulation). Your podiatrist cannot be both the certifying physician and the fitting provider under Medicare rules.

What if I have Medicare Advantage instead of Original Medicare?

Medicare Advantage (Part C) plans must cover at least the same benefits as Original Medicare, including the Therapeutic Shoe Program. However, coverage details vary by plan — some Medicare Advantage plans offer enhanced benefits with lower copays or additional pairs. Your plan may require you to use specific DME suppliers within their network. Contact your Medicare Advantage plan directly or ask our office to verify your specific benefits before scheduling a fitting. We work with most major Medicare Advantage plans in Michigan.

The Bottom Line on the Medicare Diabetic Shoe Program

The Medicare Therapeutic Shoe Program is one of the most underutilized preventive benefits in all of healthcare. Properly fitting diabetic footwear with custom inserts reduces ulcer risk by 50–60%, yet an estimated 85% of qualifying patients never access this benefit. The program costs most patients $0–50 per year and provides one pair of therapeutic shoes plus three pairs of custom inserts — a package that would cost $500–1,200 without insurance. If you have diabetes with peripheral neuropathy, foot deformity, prior ulceration, or any qualifying condition, this benefit exists specifically for you. Ask your doctor for the certification statement at your next appointment, then schedule a fitting with a certified provider. One pair of properly fitting shoes could prevent the ulcer that leads to amputation.

Sources

1. Bus SA, et al. “Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update).” Diabetes/Metabolism Research and Reviews. 2024;40(3):e3651.
2. Centers for Medicare & Medicaid Services. “Therapeutic Shoes or Inserts.” Medicare Coverage Database, 2024.
3. Lavery LA, et al. “Preventing diabetic foot ulcer recurrence in high-risk patients: use of temperature monitoring as a self-assessment tool.” Diabetes Care. 2007;30(1):14-20.
4. American Diabetes Association Professional Practice Committee. “12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2024.” Diabetes Care. 2024;47(Suppl 1):S231-S243.
5. Reiber GE, et al. “Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial.” JAMA. 2002;287(19):2552-2558.

Watch: Understanding Diabetic Foot Protection

More Diabetic Foot Care Resources

• Complete Diabetic Foot Care Guide
• Best Shoes for Diabetic Neuropathy
• Diabetic Wound Prevention Strategies
• Understanding Peripheral Neuropathy Symptoms
• Charcot Foot: What Every Diabetic Should Know

Dr. Tom’s Recommended Products: See our clinically tested product recommendations for this condition. View Dr. Tom’s recommended products →

Get Your Medicare Diabetic Shoes at Balance Foot & Ankle

If you have diabetes and Medicare coverage, you may qualify for one pair of therapeutic shoes and three pairs of custom inserts per year at no out-of-pocket cost. At Balance Foot & Ankle, we are a Medicare-approved supplier of diabetic footwear and can handle the entire process including fitting, documentation, and billing at our Howell and Bloomfield Hills offices.

→ Learn about insurance coverage
→ Book your appointment
→ Call (810) 206-1402

Clinical References

1. Bus SA, Lavery LA, Monteiro-Soares M, et al. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(S1):e3269. doi:10.1002/dmrr.3269
2. Reiber GE, Smith DG, Wallace C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes. JAMA. 2002;287(19):2552-2558. doi:10.1001/jama.287.19.2552
3. Bus SA, van Deursen RW, Armstrong DG, et al. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes. Diabetes Metab Res Rev. 2016;32(S1):99-118. doi:10.1002/dmrr.2702

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