If you are new to Medicare, you may have questions about how Medicare benefits work when it comes to your specific podiatry needs. According to the Illinois Podiatric Medical Association (IPMA), approximately 13,320 practicing podiatrists in the United States treat an estimated 14 million people (or five percent of the general population) each year. With so many Medicare recipients needing podiatry care, you are in good company as you learn more about your coverage for these services.
Podiatry Vs. Routine Foot Care – What You Should Know
Many Medicare recipients share a common misconception when it comes to podiatry and routine foot care. Understanding the important differences between the two specialties will help you navigate your Medicare coverage and help you determine what your care will cost. Routine foot care includes cutting back corns or calluses, clipping nails, treating flat foot (flattened arches) and similar types of medical care for the feet. Podiatry, on the other hand, is specialized foot care to treat or manage an underlying health issue that directly or indirectly affects the overall health and function of one or both feet.
Routine foot care that is not related to podiatry is typically excluded from Medicare coverage, but there are exceptions. For example, if you are being treated by a podiatrist for a one-time medical event or a chronic health condition, you may need routine foot care performed by a podiatrist as a part of managing or treating your condition. In this type of situation, your routine foot care treatment may be covered under Medicare Part A and/or Part B.
Does Medicare Cover Podiatric Care?
Part A (Hospital Insurance) will help cover the cost of podiatry care you receive if/when you are formally admitted to a Medicare-approved hospital. Part B (Medical Insurance) can help cover the cost of medically necessary services that take place in a doctor’s office or in an outpatient setting. The podiatry services covered under Medicare Part B will need to be ordered by your physician and deemed medically advisable or necessary.
There are specific conditions you must meet to qualify for coverage. According to the Centers for Medicare & Medicaid Services (CMS), you must be seen by a medical doctor (M.D.) or osteopath at least six months prior to your first podiatric treatment. You must also be able to show documentation of this or your podiatrist must attest to this as a part of submitting your claim. Part B will cover podiatrist foot exams and treatment if you have diabetes-related nerve damage to your foot, or if you require care to treat injuries or disease, including heel spurs, bunion deformities, or hammer toe.
Does Medicare Cover Supportive Foot Devices?
Medicare recipients being treated for diabetes-related foot disease may be covered for the furnishing and fitting of one pair of custom-molded shoes, or one-pair of extra-depth shoes once per year as long as your podiatrist prescribes them. Medicare also covers two additional pairs of inserts for custom-molded shoes or 3 additional pairs of inserts for extra-depth shoes each calendar year. As long as your supplier accepts assignment, you will likely pay 20% of the Medicare-approved amount, and the Part B deductible will apply.