Does Medicare Pay for Podiatrist Care?
Unravel Medicare's approach to podiatry. Get clarity on what foot care services are eligible for coverage and your potential costs.
Foot health plays an important role in maintaining mobility and overall well-being, particularly for older adults. As individuals age, various foot conditions can arise, impacting daily activities and quality of life. Understanding how Medicare, the federal health insurance program, covers podiatric care is important for managing healthcare needs and expectations.
Medicare’s General Podiatry Coverage
Medicare primarily covers podiatry services when they are considered medically necessary. This means the services are required to diagnose or treat an injury, disease, or condition affecting the feet. Medicare Part B, which addresses outpatient care, is the component that covers these types of podiatric treatments. For coverage to apply, the services must be provided by a licensed podiatrist or other qualified healthcare professional who is enrolled in Medicare.
The overarching principle is that Medicare does not cover routine or preventive foot care unless a specific medical condition justifies the need for professional intervention. A referral from a treating physician may also be required for coverage of specific podiatry services.
Specific Covered Foot Conditions and Services
Medicare covers a range of specific foot conditions and their treatments. This includes conditions such as hammer toe, bunion deformities, and heel spurs, which can cause pain and impair mobility. Treatment for foot infections and ingrown toenails, especially if severe, can also be covered.
Individuals with diabetes-related nerve damage can receive coverage for annual foot exams to assess risk of limb loss. Medicare also covers therapeutic shoes and inserts for those with severe diabetic foot disease, with specific allowances for one pair of custom-molded or extra-depth shoes and multiple pairs of inserts annually. Podiatrists may also order ancillary services like X-rays, laboratory tests, or physical therapy, which Medicare may cover.
Understanding Your Costs and Payment Options
Under Original Medicare, specifically Part B, patients share in the costs of covered podiatry services. After meeting the annual Part B deductible, which is $257 in 2025, individuals are responsible for 20% of the Medicare-approved amount. The remaining 80% is paid by Medicare.
If services are rendered in a hospital outpatient setting, a copayment may also apply. The amount paid can also depend on whether the podiatrist accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment. If a provider does not accept assignment, they may charge more than the Medicare-approved amount, leading to higher out-of-pocket costs. Medicare Advantage (Part C) plans must cover at least the same services as Original Medicare, but they may have different cost-sharing rules, including varying deductibles, copayments, and coinsurance amounts. These plans may also offer additional benefits beyond Original Medicare, but beneficiaries need to use in-network providers to avoid higher costs.
Services Not Covered by Medicare
Medicare has specific exclusions for podiatry services. Routine foot care, such as the cutting or removal of corns and calluses, trimming or clipping of nails, and general hygiene, falls under this exclusion. These services are considered personal care unless there is a specific medical necessity.
However, exceptions exist if routine care is performed as an integral part of other covered services or in the presence of systemic conditions, such as diabetes or peripheral vascular disease, where such care could pose a hazard if performed by a non-professional. Cosmetic procedures, like foot whitening or surgeries solely for appearance, are also not covered. Additionally, certain supportive devices for the feet, such as orthopedic shoes, are excluded unless they are an integral part of a leg brace or specifically for patients with severe diabetic foot disease.