What Do You Know About the Therapeutic Shoe Bill? You Could Get Your Diabetes Shoes for Free
Posted by Jenn F. on Monday, January 4th, 2016
You may have heard a rumor going around that “diabetics get their shoes for free,” thanks to Medicare. Studies have shown that up to 25% of diabetics will suffer some type of problem with their feet.1http://www.apexfoot.com/medicare/ Furthermore, it’s been estimated that the cost of diabetic foot ulcers is about $9 billion per year, so it makes sense to spend a little money toward the prevention of serious diabetes foot issues.2http://www.medscape.com/viewarticle/821908 The Therapeutic Shoe Bill was enacted by Congress in 1993 to provide adequate footwear and inserts for diabetics who qualify under Medicare Part B benefits. Of course, as with any freebie, there are always caveats and stipulations when it comes to getting your free slice of pie.
How to Get Therapeutic Shoes for Diabetics
In order to get your shoes covered by Medicare, the doctor treating your diabetes must certify that:3https://www.medicare.gov/Pubs/pdf/11022.pdf
- You have diabetes.
- You have at least one of these conditions in one or both feet: Calluses, nerve damage, poor circulation, foot deformity, partial or complete amputation, and/or past history of foot ulcers.
- You are being treated with a comprehensive diabetes care plan that requires therapeutic shoes.
Also, Medicare requires that a podiatrist prescribe and fit the diabetes shoes for you.
What Is Covered Under the Therapeutic Shoe Bill?
All eligible Medicare recipients who meet the above criteria can then receive:
- One pair of off-the-shelf depth shoes and up to three additional pairs of multi-density inserts.
- One pair of off-the-shelf depth shoes with a modification and up to two additional pairs of inserts.
- One pair of custom-molded shoes and up to two additional pairs of multi-density inserts.
- The dollar limit is around $300.
Medicare reimburses about $300 for one pair of off-the-shelf, extra-depth therapeutic shoes (A5500) and three sets of heat-molded multilaminar insoles (AA5512) or custom fabricated insoles (A5513). The Healthcare Common Procedure Coding System (HCPCS) is quite specific about what is reimbursable under the benefit (see table 5).
What Shoes Qualify As “Therapeutic”?
Diabetes shoes are generally made with excellent arch support and pressure reduction in mind. The toe boxes and widths tend to be wider than the average shoe and there is increased depth to accommodate custom-molded inserts.
- You can check out some of the Medicare-approved shoes at ShoeBuy.com.4http://www.shoebuy.com/medicare-approved-diabetic-shoes.htm
- The Healthy Feet Store lists a number of diabetic-specific depth shoes.5http://www.healthyfeetstore.com/diabeticshoes.html
- Zappos lists their Medicare-eligible shoes by code as “A5500.”6http://www.zappos.com/shoes/CK_XAToCyw4.zso
- There is a list of podiatrist-approved footwear and products for people with diabetes at APMA.org.7http://www.apma.org/
How Long Does It Take to Get Free Diabetes Shoes?
It’s important to understand free diabetes shoes do not show up overnight. It can take four to six weeks from the time of your evaluation for your new shoes to arrive. Insurance sometimes causes additional delays, particularly if you’re enrolled in a Medicare HMO like Blue Options (which requires pre-authorization before dispensing shoes).
What If You’re Not on Medicare?
We also educate patients to understand that Medicare is not the only avenue for receiving assistance in paying for diabetic specialty shoes. Some private carriers will cover all the cost of your diabetic footwear, depending on the company. More conservative insurers may even pay 80% or up to $500 per calendar year.
Do You Need Free Medicare Shoes?
Not every diabetic needs a pair of special orthopedic shoes. As respected orthopedist Michael S. Pinzur MD of Loyola University Medical Center put it: “The way I stratify risk is that the more deformity, neuropathy, and vascular disease that I see, the more likely that I am to want (therapeutic) devices for those patients.” He adds, “People who have no deformity, good sensation, and good blood flow, they don’t need therapeutic shoes. They need good instruction on the right kinds of shoes to wear.”
Pinzur says he orders custom footwear for about 5% of his clients. The ultimate goal is to move patients off the free TSB shoes and into a situation where they see a reversal in diabetic symptoms like low blood sugar and neuropathy.
Diabetic Foot Care in NYC
We offer diabetic foot exams and footwear consultations here at The Center for Podiatric Care and Sports Medicine in Manhattan and Westchester. We can point you to local stores or websites and specific brands that will help you adequately protect your feet. We can also measure your feet so you know exactly which size and width to purchase.
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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.