Is Diabetic Foot Care Covered By Medicaid & Medicare In New York State?
Posted by Jenn F. on Friday, August 28th, 2015
Across the country, state battles are being waged to add diabetic foot care services to Medicaid and Medicare coverage. Podiatrists say that taxpayers wind up paying huge sums of money once minor foot issues become chronic wounds in need of more invasive emergency medical treatments. Lawmakers argue that adding these services would cost too much, given the growing pool of people now eligible for the program under the Affordable Care Act’s Medicaid expansion. In Las Vegas, for instance, 160,000 new people were added.
When compared to general practitioner and emergency room doctors, diabetic foot and ankle issues “can be treated so much more cost-effectively by a podiatrist,” argued Dr. Kenneth Fatkin from Henderson, Nevada.1http://www.reviewjournal.com/life/health/failed-medicaid-foot-care-proposal-could-cost-taxpayers-more Far too often, “head-to-toe” exams by primary care physicians focus on the upper body and skim over the feet, which can be a source of great suffering for some patients. We are fortunate here in New York State to have some of the best coverage for diabetic foot care in the country.2https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedicarePodiatryServicesSE_FactSheet.pdf
What Foot Care Services Are Covered By Medicaid & Medicare In New York?
In New York State, a 2012 Medicaid expansion allowed program recipients ages 21 and older with diabetes to obtain podiatry coverage from private practicing specialists.3https://www.health.ny.gov/health_care/medicaid/program/update/2012/2012-10.htm#pod NYS Medicaid has agreed to cover “all medically necessary podiatry services,” which includes:
- Buerger’s disease
- Chronic thrombophlebitis
- Peripheral neuropathies involving the feet
- Foot issues related to malnutrition or alcoholism
- Pernicious anemia
- Multiple sclerosis foot issues
- Renal disease foot issues
- Leprosy and neurosyphilis
- Hereditary disorders
- Traumatic injuries
- Plantar wart removal
- Toenail infections when there is pain, secondary infection or limited mobility
When diabetic patients are diagnosed with neuropathy and loss of sensation in the feet, Medicare and Medicaid pay for routine examination and treatment of the feet once every six months. Electromagnetic therapy is now covered for the treatment of chronic Stage III and Stage IV ulcers.4http://www.ncbi.nlm.nih.gov/pubmed/25882659 Hyperbaric Oxygen Therapy for wounds is also covered when 30 days of standard wound therapy fails to work. Therapeutic shoes that include custom molding, adding depth or special inserts may also be covered.
What’s Not Covered?
Services and products that may not be covered include:
- Corn removal
- Callus removal
- Nail trimming, cutting, or debridement
- Cleaning and foot soaks for preventative maintenance
- Skin creams to maintain skin tone in ambulatory or bed-ridden patients
- Treatments in the absence of foot pain, illness or infection
- Supportive devices and orthotic inserts for the treatment of flat foot or general foot pain
How To Get Diabetic Foot Care Services Covered By Insurance In New York
The Center for Podiatric Care and Sports Medicine in New York City is happy to help you obtain coverage for diabetic podiatry services from Medicare or Medicaid. Expert medical practitioners at our two offices (in Manhattan and Westchester) typically begin treatment with the most affordable and conservative options, but we also offer the most effective advanced therapies for our diabetic patients, including: Transcutaneous Electrical Nerve Stimulation, ultrasonic debridement, hyperbaric oxygen, laser toenail fungus removal, low-level laser therapy and more. We do everything we can to get services covered by insurance. In the event insurance does not cover a particular service, we can help you explore other options like a CareCredit loan, payment plan, or health savings account.
In order to have your podiatry services covered, you will need a written referral from your general physician that confirms your diagnosis of diabetes. Our office will provide our private practicing podiatrist ID information to Medicaid or Medicare on your behalf when submitting your claim for coverage. In addition to accepting Medicaid and Medicare, our office also accepts a number of private health insurance plans as well. For more details on insurance coverage for NY foot care, check out our blog post “Insurance From Head To Toe.”
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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports Medicine. Dr. Josef J. Geldwert, Dr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.