Therapeutic Shoes for Diabetes: Medicare Coverage and Getting Fitted

Therapeutic Shoes for Diabetes: The Medicare Program Explained

The Medicare Therapeutic Shoes for Persons with Diabetes program (also called the Diabetic Shoe Bill, Section 4072 of OBRA 1987) is a Medicare Part B benefit that covers the fitting and provision of therapeutic footwear for qualifying diabetic patients. Each calendar year, the program covers one pair of depth-inlay shoes plus three pairs of custom-molded inserts, or one pair of custom-molded shoes (for patients with significant foot deformity) plus two pairs of inserts. This benefit is designed to prevent diabetic foot ulcers and amputations — the most expensive and devastating complications of diabetic peripheral neuropathy.

Who Qualifies for Medicare Therapeutic Shoes?

To qualify for Medicare therapeutic shoes, the patient must have Medicare Part B, have a diagnosis of diabetes mellitus (Type 1 or Type 2), and have at least one of the following qualifying conditions documented in the medical record: peripheral neuropathy with evidence of callus formation; a history of pre-ulcerative callus; a history of foot ulcer; foot deformity; previous amputation of a foot or part of a foot; or poor circulation (peripheral arterial disease). The treating physician (typically the primary care physician or endocrinologist managing the diabetes) must certify medical necessity by signing a Certificate of Medical Necessity (CMN). The podiatrist then fits, prescribes, and provides the shoes and inserts.

What Are Therapeutic Diabetic Shoes?

Medicare-covered therapeutic shoes are not ordinary athletic shoes — they are medical-grade footwear with specific features designed to reduce pressure, prevent skin breakdown, and accommodate foot deformities. Depth-inlay shoes have extra depth (typically 3/8 to 1/2 inch deeper than standard shoes) to accommodate custom inserts and accommodate hammertoes or other deformities without rubbing the toe tops. They have seamless interiors to eliminate irritation points that cause blisters in neuropathic patients. Custom-molded inserts are fabricated from a cast or scan of the patient’s foot and provide precise total-contact cushioning that distributes weight away from pressure-prone areas. Heat-moldable inserts are fitted in the office and contoured to the individual foot shape.

Getting Therapeutic Shoes at Balance Foot & Ankle

At Balance Foot & Ankle, Dr. Tom Biernacki and Dr. Carl Jay provide therapeutic shoe fitting and dispensing at both the Howell and Bloomfield Hills offices. We handle the CMN documentation, coordinate with your primary care physician for certification, and fit you with appropriate therapeutic footwear selected from our diabetic shoe inventory. Most qualifying Medicare patients pay nothing out of pocket after Medicare pays 80% and a secondary insurer covers the remaining 20%. Call (810) 206-1402 to determine your eligibility and schedule a therapeutic shoe fitting.

For a complete clinical overview: Podiatrist-Recommended Shoes Guide — shoe recommendations for every foot condition