What Podiatry Services Are Covered By Medicare?
Posted by Jenn F. on Friday, July 12th, 2013
If you have something wrong with your foot, you need not suffer. Medicare covers a wide range of conditions treated by a podiatrist. It’s best to know what is or isn’t covered before you call a doctor, so you can avoid paying out-of-pocket for unnecessary tests or procedures. Here at our NYC Center for Podiatric Care and Sports Medicine, we are happy to call and confirm your coverage before you have any work done, so you know exactly what to expect.
What Medicare won’t cover:
Generally speaking, Medicare DOES NOT cover:
1. Treatment of flat foot – Flat foot is when one or more of the foot’s arches have flattened out, causing discomfort. Supportive devices are not covered.
2. Routine foot care – Removal of corns and calluses, toenail cutting / nail debridement, cleaning, soaking, applying cream, and other hygienic or preventative maintenance care is not covered UNLESS you fall into a certain category, which we’ll discuss in a moment.
3. Supportive devices – Medicare usually does not cover orthopedic shoes or custom orthotics, unless it is part of a leg brace. There are, however, exceptions to this rule.
What Medicare will cover:
Medicare agrees to cover any foot care services that are reasonable and medically necessary. These conditions include:
- Diabetes mellitus
- Arteriosclerosis obliterans
- Buerger’s disease
- Chronic thrombophlebitis
- Peripheral neuropathies involving the feet
- Malabsorption / Celiac Disease
- Pernicious anemia
- Multiple Sclerosis
- Chronic Renal Disease
- Traumatic Injury
- Leprosy / Neurosyphilis
- Hereditary Disorders
Medicare may also cover the treatment of plantar warts, mycotic nails, infected toenail plates and secondary foot infections. They will also cover hammer toes, bunion deformities, and heel spurs.
What about long-term, chronic foot care treatments?
Medicare will cover checkups every six months for beneficiaries with a documented diagnosis or sensory neuropathy and loss of protective sensation — notably found in diabetics. Electrostimulation therapy for wound healing is covered for chronic Stage III and Stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers, as long as certain conditions are met. Hyperbaric Oxygen Therapy for hypoxic and diabetic wounds of the lower extremities is also covered in patients with Type I or Type II Diabetes who have wounds of Wagner grade III or higher and failed to see any measurable results from standard wound therapy after 30 days. Coverage for custom-molded therapeutic shoes and inserts for diabetics is also available.
The Bottom Line:
According to the official Medicare website, you will be responsible for covering 20% of the cost for a medically necessary treatment, the Part B deductible as listed on your plan, and a hospital copay if necessary. The NYC Center for Podiatric Care and Sports Medicine accepts Medicare plans and will work with you to see that all treatments are within your coverage and budget. Do not hesitate to call us with any questions you may have about podiatry services in the New York City area.
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.