Medicare’s Therapeutic Shoe Bill (A5500 codes) covers one pair of diabetic shoes plus 3 pairs of inserts annually for qualifying patients. The right pair prevents the foot ulcers that lead to amputations.
You’re in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what Medicare Therapeutic Shoe Bill means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
Medically reviewed by Dr. Tom Biernacki, DPM · Board-Certified Podiatric Surgeon · Last reviewed: April 2026 · Editorial Policy
Treatment at Balance Foot & Ankle: Diabetic Foot & Circulation Screening →
Medically reviewed by Dr. Tom Biernacki, DPM — Board-certified foot & ankle surgeon, 3,000+ surgeries performed. Updated April 2026 with current clinical evidence. This article reflects real practice experience from Balance Foot & Ankle Specialists in Howell and Bloomfield Hills, Michigan.
Quick Answer
Diabetic peripheral neuropathy is nerve damage from prolonged hyperglycaemia, causing burning, tingling, numbness, or loss of protective sensation in the feet. It will not reverse without addressing glucose control. Daily foot checks, proper footwear, and annual monofilament testing prevent ulceration.
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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
The Medicare Therapeutic Shoe Bill (Section 4149 of the Omnibus Budget Reconciliation Act of 1987) provides Medicare Part B coverage for one pair of therapeutic shoes and three pairs of custom inserts (or two pairs of depth shoes and two pairs of inserts) per calendar year for qualifying Medicare beneficiaries with diabetes mellitus — one of the most underutilized and impactful preventive benefits in Medicare. Patients who qualify for and use therapeutic shoes have significantly reduced rates of foot ulceration, hospitalization, and amputation, yet fewer than 20% of eligible patients receive this benefit.
Eligibility Requirements
To qualify for Medicare therapeutic shoe coverage, the patient must meet ALL of the following: (1) diagnosis of diabetes mellitus; (2) certification of medical necessity from the patient’s treating physician or podiatrist — documentation of one or more of the following conditions: peripheral neuropathy with evidence of callus formation; history of pre-ulcerative calluses; history of previous foot ulceration; foot deformity; previous amputation of the foot or part of the foot; poor circulation. The certifying physician or podiatrist must document the diabetic condition and at least one qualifying condition in the patient’s medical record. The prescribing practitioner (podiatrist, physician, or qualified non-physician practitioner) writes the prescription specifying shoe type, size, and any custom modifications. The therapeutic shoe supplier (a certified pedorthist or orthotist) fits and dispenses the shoes and submits the claim to Medicare.
What Medicare Covers and Practical Use
Covered items: depth-inlay shoes (extra-depth shoes with removable insoles that accommodate custom orthotics without pressure points); custom-molded shoes (fabricated from a cast of the patient’s foot — for severe deformity that cannot be accommodated by depth shoes); custom inserts (prescription insert devices fabricated from foam or other materials to accommodate bony prominences, relieve ulcer sites, and distribute plantar pressure). Medicare payment: 80% after the Part B deductible; Medicare supplement (Medigap) or Medicaid covers the remaining 20% for most patients. Practical guidance: the therapeutic shoe visit is best combined with the annual diabetic foot examination — the podiatrist documents the required qualifying conditions, writes the shoe prescription, and coordinates with the shoe supplier; new shoes are available each January 1. The benefit is separate from custom orthotic coverage. Dr. Biernacki at Balance Foot & Ankle provides Medicare therapeutic shoe prescriptions and documentation for qualifying diabetic patients at our Bloomfield Hills and Howell offices. Call (810) 206-1402 to schedule your annual diabetic foot exam and therapeutic shoe evaluation.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
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.
More Podiatrist-Recommended Diabetic Essentials
Diabetic-Approved Walking Shoe
Orthofeet Sprint — seamless, extra-depth, designed for neuropathic feet.
Seamless Diabetic Sock
Watch: Diabetes Peripheral Neuropathy Treatment [Diabetic Nerve Pain Remedy] — MichiganFootDoctors YouTube
OS1st FS4 — non-binding, moisture-wicking, protects fragile diabetic skin.
Recovery Slide for Indoor Wear
HOKA Ora 3 — protects diabetic feet from barefoot injury at home.
As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. Product recommendations are based on clinical experience; prices and availability shown above update live from Amazon.
When to See a Podiatrist
One unnoticed blister on a neuropathic foot can become a limb-threatening ulcer in under 14 days. Medicare covers diabetic shoes (A5500) and comprehensive foot exams annually for most diabetic patients with neuropathy or circulation concerns. Balance Foot & Ankle runs a dedicated diabetic limb-preservation program — vascular screening, offloading, ulcer care, and shoe fitting — all in one visit. Schedule your annual diabetic foot exam today.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
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.
Book Online or call (810) 206-1402
Insurance Accepted
BCBS · Medicare · Aetna · Cigna · United Healthcare · HAP · Priority Health · Humana · View All →
Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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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.
In Our Clinic
Diabetic neuropathy patients in our clinic often don’t realize they have it until we put a 10-gram Semmes-Weinstein monofilament to the plantar foot and they can’t feel it. Many arrive for an unrelated concern — an ingrown toenail, a callus — and we catch the neuropathy on screening. The conversation then shifts: we need to discuss daily foot inspections, appropriate footwear, the urgency of any blister or open area, and the timing of vascular referral if pulses are diminished. Comprehensive diabetic foot exams are covered by Medicare annually. If you have diabetes, we want to see you once a year even if nothing hurts.
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
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Sudden loss of sensation on one side
- Wound on the foot not felt by the patient
- One-sided symptoms (rule out compression)
- Back pain plus leg symptoms (possible radiculopathy)
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
Pros & Cons of Conservative Care for diabetic foot care
Advantages
- ✓ Daily inspection prevents amputation
- ✓ Most insurance covers DME
- ✓ Custom orthotics help
Considerations
- ✗ Daily commitment required
- ✗ Slow wound healing
- ✗ Charcot risk if neuropathy
Dr. Tom’s Recommended Products for diabetic foot care
Affiliate disclosure: As an Amazon Associate, Balance Foot & Ankle earns from qualifying purchases. We only recommend products we use with patients.
Drew Moonwalker Diabetic Shoe Dr. Tom’s Pick
Best for: Medicare-covered diabetic footwear
Diabetic Compression Socks Dr. Tom’s Pick
Best for: Daily protection + circulation
Ready to Get Back on Your Feet?
Same-day appointments in Howell + Bloomfield Twp. Most insurance accepted. Dr. Tom Biernacki, DPM & team.
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About Your Care Team at Balance Foot & Ankle
Dr. Tom Biernacki, DPM · Board-Certified Foot & Ankle Surgeon. Specializes in conservative-first care, minimally invasive bunion surgery, and complex reconstruction.
Dr. Carl Jay, DPM · Accepting new patients. Specializes in sports medicine, athletic injuries, and routine podiatric care.
Dr. Daria Gutkin, DPM, AACFAS · Accepting new patients. Specializes in surgical reconstruction and pediatric podiatry.
Locations: 4330 E Grand River Ave, Howell, MI 48843 · 43494 Woodward Ave Suite 208, Bloomfield Twp, MI 48302
Hours: Mon–Fri 8:00 AM – 5:00 PM · (810) 206-1402
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.
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Same-week appointments at our Howell and Bloomfield Hills offices. Board-certified podiatric surgeons. Most insurance accepted.
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?
- Plantar Fasciitis: Diagnosis and Conservative Management (PubMed)
- Plantar Fasciitis (APMA)
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
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