While routine foot maintenance, including the removal of calluses and corns, nail care, and general cleaning or soaking, is not covered by Medicare, the program does make some exceptions for diabetic individuals. 

It’s important to understand the full range of services that Medicare does cover in this area, so you can take advantage of the benefits and maintain optimal foot health.

Does Medicare cover podiatry for diabetics?

Individuals living with diabetes are often more susceptible to nerve damage in the lower legs, which can increase the risk of limb loss if not adequately managed. In response to this medical reality, Medicare has provisions for annual foot exams for people with lower leg nerve damage due to diabetes. This means that you are eligible for a foot exam once a year, provided you have not consulted a foot care professional for any other reason between these annual visits.

If you’re confused about what a foot exam includes, then you can have a look at this Medicare diabetic foot exam form to see what is included.

Furthermore, diabetes can lead to alterations in the form of your feet and toes. As per the US Department of Health and Human Services, Medicare provides coverage for diabetic foot care by funding one pair of therapeutic shoes and the associated orthotic insoles every year. These shoes and insoles are exclusively designed for those grappling with serious diabetic foot complications.

These items can be obtained either directly from the doctor performing your check-up or from a certified healthcare practitioner such as an orthotist (a specialist in designing and adjusting braces and splints for foot ailments or disorders), a pedorthist (a professional in altering and fitting therapeutic shoes or orthotic supporting devices), or a prosthetist (an expert who fabricates prosthetics for individuals with disabilities).

Furthermore, Medicare extends its coverage to include specific foot-related procedures for diabetics. These procedures are particularly essential as they may pose a hazard if performed by patients themselves due to potential complications.

While Medicare Part B does cover these services, there are still out-of-pocket costs to consider. You will need to pay the 2024 deductible of $240. Once this deductible has been met, Medicare will then cover 80% of the costs of the exam, procedure, or item. Understanding these costs can help you plan your healthcare budget accordingly and ensure that you receive the care you need.

How often does Medicare pay for diabetic foot care?

Medicare covers diabetic foot care based on medical necessity since diabetics are at high risk of neuropathy which can require limb amputation. Hence, Medicare covers an annual foot exam for those with diabetes-related lower leg nerve damage. Beyond this, if your doctor determines that a foot procedure is “medically necessary” for your well-being, Medicare will cover it as often as required. 

Does Medicare cover toenail clipping for diabetes? 

While routine foot care services, such as toenail clipping or the removal of corns and calluses, are generally not covered by Medicare Part B, an exception is made for individuals with diabetes. For this group, these otherwise routine procedures could pose a hazard if performed by a non-professional. 

Therefore, Medicare Part B covers toenail clipping for diabetics if it is deemed medically necessary by your healthcare provider. The provider must certify that potential health harm could result if the procedure is not performed by a podiatrist or other qualified medical professional. It’s a critical provision that underscores the importance of specialized care for individuals with diabetes.

Does Medicare cover pedicures for diabetics?

Medicare’s coverage is primarily focused on medically necessary treatments. Thus, routine foot care services such as pedicures, even for individuals with diabetes, are not covered. This is because pedicures are typically seen as aesthetic procedures rather than essential medical treatments.

Medicare diabetic foot care guidelines 2024

Here’s a summary of the Medicare guidelines for diabetic foot care:

• Annual Foot Exam: Medicare covers a foot exam once a year for individuals with diabetes-related nerve damage in the lower legs, given no other foot care consultation has occurred in between.
• Therapeutic Shoes and Inserts: For those with severe diabetic foot disease, Medicare covers one pair of therapeutic shoes and orthotic inserts each calendar year.
• Qualified Suppliers: Therapeutic shoes and inserts can be obtained from a physician or a medically licensed orthotist, pedorthist, or prosthetist.
• Medically Necessary Procedures: Certain foot-related procedures considered hazardous if done by patients themselves are covered.
• Deductible and Coinsurance: Beneficiaries must first pay the Part B deductible, which is $240 in 2024, and then Medicare covers 80% of the costs of approved services.
• Exclusion of Routine Foot Care: Routine foot care, including toenail clipping or corn and callus removal, is generally not covered, except in specific cases where a healthcare provider certifies it to be medically necessary.
• Non-coverage of Pedicures: Pedicures are not deemed medically necessary and hence are not covered under Medicare.

Article updated on January 12, 2024