Does Medicare Cover Diabetic Foot Exams or Podiatry Services?
This article was updated on: 10/21/2018
If you have been diagnosed with diabetes and are enrolled in Original Medicare (Part A and Part B), you may be eligible for coverage of regular foot exams and diabetic foot care, subject to certain requirements. Read on to learn more about your benefits.
Why do I need a diabetic foot exam?
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 60 to 70 percent of people with diabetes develop a form of diabetic neuropathy, which is a type of nerve disorder caused by diabetes. The most common type of diabetic neuropathy is peripheral neuropathy, which may cause pain or loss of sensation in the toes, feet, legs, hands, or arms. Long-term exposure to the metabolic effects of high blood sugar may cause damage to the nerves, often concentrated in the toes, feet, and legs. This nerve damage may cause numbness, tingling, foot deformities such as hammertoes, and may even change the way a person walks.
As a result, blisters and sores often develop on pressure points and may go unnoticed due to loss of sensation in the feet and toes. If these sores aren’t treated promptly, infections may develop and can lead to gangrene. If treatments don’t work, amputation may be required to prevent life-threatening complications.
A diabetic foot exam by a podiatrist or provider certified in foot care can detect potential problems before they occur or develop into more serious conditions.
According to the NIDDK, during a diabetic foot exam, your health-care provider will:
- Carefully inspect the feet for cracks, sores, signs of infection, and bony deformities.
- Test the feet for signs of nerve damage.
- Test blood flow to the feet and legs.
- Trim your toenails if you can’t trim your own.
- Show you how to care for your feet and manage any potential problem areas.
- Determine if special shoes or inserts will help your feet stay healthy.
How often should I have a diabetic foot exam?
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), you should visit your doctor once a year for a diabetic foot exam, or more often if you have foot problems. During the diabetic foot exam, have your physician check for adequate blood flow and for any sign of loss of feeling in your feet.
Please note that according to the NIDDK, smoking can narrow and harden the blood vessels that deliver oxygen and nutrients to your nerves, and nerve damage and decreased blood flow can cause major foot problems. Thus, diabetes and smoking are not a good mix. Please see this article about smoking cessation if you need help quitting. To keep your feet healthy, the NIDDK recommends keeping your blood glucose numbers close to the target you and your doctor have set, and making sure to check your feet every day for problems.
How often does Medicare cover a diabetic foot exam?
If you have diabetes, diabetic neuropathy, and loss of protective sensation in your foot, Medicare Part B (medical insurance) covers one diabetic foot exam every six months, provided you have not been treated by a foot care specialist for another condition between exams. If you go to a Medicare-assigned doctor’s office for a diabetic foot exam, you pay 20% of the allowable charges plus any applicable Part B deductible. If you see a specialist in an outpatient hospital clinic, you are usually responsible for a copayment.
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), does not cover routine podiatry services (like the removal of corns and calluses or hygienic maintenance). But, medically necessary treatment of foot deformities or injuries such as bunions and hammertoes may be covered at 80% of any allowable charges (you’ll need to pay the remaining 20% plus any applicable deductible).
Some people choose an alternate way to receive their Medicare benefits through a Medicare Advantage plan. These plans must cover the same services as Original Medicare (except hospice care, which is still covered under Part A), but in many cases, they provide additional benefits including prescription drug coverage, routine vision and dental care, and may even offer podiatry services. Please check the Medicare Advantage plan details as benefits may vary. Please also note that you’ll still need to pay your Medicare Part B premium, as well as any Medicare Advantage plan premium, along with deductibles, copayments, and coinsurance.
If you have questions about Medicare plan options and coverage of your diabetic foot exam or other podiatry services you may need, I’m happy to discuss them with you. Click one of the links below to request a telephone call or personalized email with information just for you. You can find out more about me by clicking the “View profile” link below. You can also view a list of plan options in your area you may be eligible for by clicking the Compare Plans button.
For more information about diabetes foot exams, please see:
“Diabetes and Foot Problems,” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), last updated February 2014, https://www.niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/keep-feet-healthy