85.5%. That is the share of improper Medicare payments for diabetic shoes in the 2024 reporting period that the Centers for Medicare & Medicaid Services traced to insufficient documentation. The shoes were rarely the problem. The paperwork was.
A diagnosis is not enough
Medicare covers one pair of therapeutic shoes with inserts each year for people with diabetes, but diabetes alone does not open the door. The patient also needs severe diabetes-related foot disease. CMS names two qualifying situations: a previous amputation of the other foot or part of either foot, or peripheral neuropathy with evidence of callus formation. Numb feet without recorded calluses fall short.
The doctor who manages the patient’s diabetes has to document the foot problem, or review and sign off on another qualified clinician’s findings, before certifying the need for shoes.
Who signs, and when
That same doctor certifies three points: the patient meets the standard, is under a comprehensive diabetes care plan, and needs the shoes. The timing rules are tight. The doctor must have seen the patient in person about diabetes within six months before the shoes are delivered, and must sign the certification within three months before delivery. A checkup from last winter can lapse by the time of a fall fitting.
The prescription can come from a podiatrist, nurse practitioner or physician assistant, or from the diabetes doctor. Every clinician and the supplier must be enrolled in Medicare. Enrollment is one question, and whether the supplier accepts Medicare’s approved rate is another, so patients should ask both.
What the benefit pays
Depending on foot needs, each calendar year Medicare covers either one pair of extra-depth shoes plus three pairs of inserts, or one pair of custom-molded shoes with inserts plus two extra pairs of inserts when a deformity rules out extra-depth shoes. After the yearly Part B deductible, the patient pays 20% of the approved amount if the supplier accepts assignment. A supplier that does not accept assignment can charge any amount, and the patient covers what exceeds Medicare’s figure.
A checklist before the fitting
A signed certification does not stand alone. The medical record must back it up with the qualifying foot condition, and a checked box cannot replace exam notes. If a podiatrist examined the feet, those notes should reach the diabetes doctor for review. Work backward from delivery day to confirm the visit and the signature both fall inside their windows, and ask the supplier to check the dates before anything ships.
If a claim is already denied, the Medicare Summary Notice states the reason, the amount the patient may owe and the appeal instructions. A denial does not automatically make the whole supplier bill the patient’s responsibility, and the appeal deadline still applies.
Sources
- Medicare Covers One Pair of Diabetic Shoes a Year. Missing Paperwork Drove 85.5% of Improper Payments. Her Diagnosis Alone Won’t Get the Bill Paid
- Medicare (United States)
- Is your Medicare Advantage plan ending next year? Here's what to know
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