Does Medicare Cover Podiatrist Visits?

Medicare, the federal health insurance program, covers millions of Americans. Understanding its coverage, especially for specialized care like podiatry, is important. This article details Medicare’s podiatric coverage, including services, conditions, and costs.

Medicare Part B Podiatry Coverage

Medicare Part B covers outpatient podiatry services. Services must be medically necessary, meaning treatment is required to diagnose or treat a foot injury, disease, condition, or its symptoms. Part B covers examinations, diagnoses, and treatments for foot-related medical issues. Providers must accept Medicare assignment, which means they agree to accept the Medicare-approved amount as full payment.

Specific Covered Foot Conditions and Treatments

Medicare Part B covers specific medically necessary foot conditions and treatments. This includes care for foot injuries, infections, and diseases affecting the feet and lower limbs. Conditions like bunions, hammertoes, and heel spurs are covered if medical intervention alleviates symptoms or prevents complications.

Comprehensive foot exams and ongoing diabetic foot care are also covered, especially for conditions like neuropathy or poor circulation that can lead to ulcers. Routine foot care, such as cutting corns or calluses or nail trimming, is generally not covered unless a systemic condition, like severe diabetes, makes it medically necessary to prevent further health issues. In such cases, routine care may be covered every 61 days.

Services Not Covered by Medicare

Medicare generally does not cover routine foot care services, including cutting or removal of corns and calluses, or nail trimming. These are considered personal care and are not covered unless an underlying medical condition necessitates them to prevent more serious health problems. Services like orthopedic shoes, arch supports, or custom inserts are usually not covered. An exception exists if these items are an integral part of a medically necessary covered treatment, such as therapeutic shoes or inserts for severe diabetic foot disease.

Medicare Costs and Accessing Podiatry Care

Beneficiaries are responsible for financial obligations for covered podiatry services under Medicare Part B. For 2025, the annual Part B deductible is $257. After meeting this, individuals typically pay 20% of the Medicare-approved amount for most outpatient services, including podiatry care, with Medicare covering the remaining 80%.

To ensure services are billed correctly and minimize unexpected costs, it is important to see a podiatrist who accepts Medicare assignment. Beneficiaries can locate Medicare-approved providers online or by contacting Medicare. While a referral from a primary care physician is not always required for Original Medicare, it may be necessary depending on the specific Medicare plan, such as a Medicare Advantage Plan.