How Often Does Medicare Pay for Diabetic Foot Care?
Get clear answers on Medicare's coverage for diabetic foot care. Discover covered services, frequency limits, and patient costs.
Diabetes significantly impacts overall health, and its effects on the feet require careful management to prevent serious complications. Reduced blood flow and nerve damage, known as neuropathy, can lead to ulcers, infections, and amputation if not properly addressed. Understanding Medicare’s coverage for specialized foot care services is important for individuals navigating these health challenges. This article clarifies Medicare’s provisions for diabetic foot care, helping beneficiaries understand what is covered and under what conditions.
Medicare Coverage for Diabetic Foot Care
Medicare distinguishes between routine and medically necessary foot care. Routine services, such as simple toenail trimming, corn or callus removal, and general hygienic maintenance, are typically not covered. These are considered personal care items unless a specific medical condition warrants professional intervention.
Medicare Part B covers medically necessary foot care, particularly for individuals with diabetes. This includes services for conditions arising from diabetes-related lower leg nerve damage that could increase the risk of limb loss. Covered services include comprehensive foot examinations, treatment for foot ulcers, and wound care.
Coverage also extends to issues like infected nails, hammer toe, bunion deformities, and heel spurs, provided these treatments are medically necessary. Medicare also covers specialized therapeutic shoes and inserts, which are designed to prevent complications for those with severe diabetic foot disease. These services must be prescribed by a physician and delivered by qualified healthcare professionals, such as podiatrists or other medical doctors.
Frequency and Limitations of Coverage
Medicare outlines specific frequencies for covered diabetic foot care services, emphasizing medical necessity. For individuals with diabetic peripheral neuropathy and documented loss of protective sensation, a foot exam can be covered every six months. This coverage applies as long as the beneficiary has not seen another foot care professional for a different reason during that interval.
More frequent foot care may be covered if severe conditions or complications exist, such as active foot ulcers or a high risk of amputation due to advanced neuropathy. In such instances, Medicare may cover routine foot care as often as medically necessary, sometimes as frequently as every 60 days. The treating physician must continuously document medical necessity to support any increased frequency.
Therapeutic footwear also has specific coverage limits under Medicare. Beneficiaries are generally eligible for one pair of custom-molded shoes, including inserts, and two additional pairs of inserts each calendar year. Alternatively, one pair of extra-depth shoes and three pairs of inserts are covered annually. Medicare also covers shoe modifications as a substitute for inserts, ensuring appropriate support and protection for the feet.
Conditions for Coverage and Costs
To qualify for Medicare coverage of diabetic foot care, individuals must have a confirmed diabetes diagnosis and specific foot conditions that pose a significant risk for complications. These conditions include a history of partial or complete foot amputation, previous foot ulceration, pre-ulcerative calluses, nerve damage with signs of calluses, poor circulation, or foot deformities. All services must be prescribed and supervised by a doctor of medicine or osteopathy, with thorough documented medical necessity.
Services must be performed by qualified professionals, such as podiatrists, medical doctors, pedorthists, orthotists, or prosthetists, who are enrolled in Medicare. For therapeutic shoes, the physician treating the diabetes must certify the need, and a qualified medical professional must then prescribe the footwear.
Covered diabetic foot care services fall under Medicare Part B, which entails certain patient financial responsibilities. After meeting the annual Medicare Part B deductible ($257 in 2025), beneficiaries are typically responsible for a 20% coinsurance of the Medicare-approved amount. Most individuals also pay a standard monthly Part B premium ($185 in 2025). An additional copayment may apply if services are received in a hospital outpatient setting. While Medicare Advantage Plans (Part C) must offer at least the same coverage as Original Medicare, their specific costs, deductibles, and network rules can vary.