Medicare Coverage for Therapeutic Shoes, Inserts, AFOs, and KAFOs

Health insurance is a complicated business, and Medicare is no exception. If you’re a Medicare recipient and in need of therapeutic shoes, inserts, an AFO, or a KAFO, follow the guidelines below to ensure you get the coverage you need.

Diabetic Shoes and Inserts

Medicare recipients are entitled to one pair of custom-molded shoes with inserts or one pair of extra-depth shoes each calendar year. Medicare also covers two additional pairs of inserts each calendar year for custom-molded shoes and three pairs of inserts each calendar year for extra-depth shoes.

However, to receive this coverage, a podiatrist or qualified doctor must prescribe these items. Patients must also have been seen by the doctor treating their diabetes no more than 90 days prior to receiving the shoes.

If you meet the above requirements and your provider accepts Medicare, you’ll pay 20% of the Medicare-approved amount with the Part B deductible applied.

Don’t let a missing document stop you from getting the diabetic shoes or inserts you need. Review this Medicare document checklist to make your order easy and painless.

AFOs and KAFOs

Medicare will also cover AFO and KAFO prescriptions, although additional documentation and notes are necessary to receive full benefits.

Documentation from the ordering physician, such as chart notes and medical records, is required for coverage. Other required details include the history of the injury, illness, or condition, description of limitations of a typical day, status of the current orthosis, and reason for replacement.

Don’t forget any of the paperwork required for your AFO or KAFO. Review this list of documentation required by Medicare.