Does Medicare Cover Podiatry Visits?
Get clarity on Medicare's podiatry coverage. Understand which foot care services are included, excluded, and your out-of-pocket costs.
Medicare is a federal health insurance program for individuals aged 65 or older, as well as some younger people with disabilities or specific diseases. A common question among beneficiaries concerns coverage for podiatry services. Understanding Medicare’s specific guidelines for podiatric care can be challenging due to varying coverage rules and conditions.
Medically Necessary Foot Care
Medicare’s coverage for podiatry services primarily hinges on “medical necessity.” This means the service must be required to diagnose or treat an illness, injury, condition, or its symptoms. Coverage is provided when podiatry services directly address a specific medical condition, rather than for routine or preventative care.
A doctor’s referral or diagnosis is often a prerequisite for coverage, especially for certain conditions or plans. Medicare assumes that services performed by a podiatrist are medically necessary if they treat an injury or disease, or are related to nerve damage caused by diabetes. Without a medical need or a doctor’s referral, beneficiaries pay 100% of the costs.
Specific Covered Podiatry Services
Medicare Part B covers medically necessary treatments for various foot conditions. This includes comprehensive care for diabetic foot complications, such as nerve damage, poor circulation, and foot ulcers that require professional treatment to prevent severe outcomes like amputation. Medicare covers an annual foot exam for individuals with diabetes-related nerve damage, provided they haven’t seen a foot care professional for another reason between visits.
Treatment of foot injuries, such as fractures or sprains, and serious foot infections are covered. Deformities like bunions, hammer toes, and heel spurs are covered if they require surgical correction or other medical intervention due to pain or interference with daily activities. Ingrown toenails are covered if they are infected or causing severe pain. Services like debridement of corns or calluses may be covered if a patient has a systemic condition, such as diabetes or peripheral vascular disease, that makes routine care hazardous.
Services Not Included
Medicare does not cover routine foot care services, as these are considered the patient’s responsibility or are preventive. Excluded services include cutting or removing corns and calluses, trimming nails, and other hygienic maintenance for healthy individuals. This exclusion applies regardless of the difficulty or complexity of the procedure.
Treatment for flat feet is not covered, including supportive devices, unless related to a specific medical condition requiring intervention. Custom orthotics are not covered, though an exception exists for therapeutic shoes and inserts for certain patients with severe diabetic foot disease. Cosmetic foot surgery and general hygienic care are also not covered.
Understanding Your Medicare Costs
Medically necessary podiatry services are covered under Medicare Part B, which is the medical insurance component of Original Medicare. After meeting the annual Part B deductible, beneficiaries are responsible for 20% of the Medicare-approved amount for these services. If services are provided in a hospital outpatient setting, an additional copayment may apply.
For beneficiaries enrolled in a Medicare Advantage (Part C) plan, their plan must cover at least what Original Medicare covers. These plans may have different cost-sharing rules, such as copayments or deductibles, and might require referrals for specialist visits. Beneficiaries should confirm with their specific plan about referral requirements and cost-sharing details. Ensuring the chosen podiatrist accepts Medicare assignment is important, as they agree to accept the Medicare-approved amount as full payment, which helps manage out-of-pocket costs.