Podiatry for Diabetics - What Does Medicare Cover?

The Importance of Podiatry for Diabetics

Of the many additional components of health care required by diabetics, podiatry positively falls on the list. But what does Medicare cover in terms of podiatry?

The first thing to establish is how vital podiatry is for those suffering diabetes.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, 60 to 70 percent of diabetics generate what’s known as diabetic neuropathy. This is a type of nerve damage caused by high blood sugar levels. There are three types of diabetic neuropathy, including peripheral neuropathy, autonomic neuropathy and focal neuropathy.

Peripheral neuropathy involves damage to the peripheral nerves, as the name implies. This typically leads to numbness and pain in the hands and feet. The most common cause of peripheral neuropathy is diabetes mellitus.

Autonomic neuropathy is a “group of symptoms” that involves damage to nerves associated with the spinal cord and brain. This is associated with alcohol abuse, nerve inflammation disorders and other conditions, along with diabetes. There are a number of symptoms, ranging from constipation to diarrhea and other digestive problems. Bladder issues, heart rate problems and urinary problems are also associated with autonomic neuropathy.

Finally, focal neuropathy is a condition that involves single nerves. This is the least common type of diabetic neuropathy. Entrapments, the compression or “trapping” of nerves, are more common among diabetics than those without diabetes. Among the most common type of entrapment is carpal tunnel syndrome.

In terms of Medicare-covered podiatry, the general rule of thumb is that only medically necessary and “reasonable” foot care is comprised.

Diabetic care in the form of a foot examination by a podiatrist can prevent this damage, which in turn can prevent more problems down the line – including gangrene and even foot amputation.

In essence, this sort of preventative podiatry care is definitely medically necessary.

Medicare Coverage of Podiatry Exams

Patients with diabetes, diabetic neuropathy or loss of sensation in the foot are eligible to have one diabetic foot examination covered every six months. This falls under Medicare Part B and there are conditions. Recipients of coverage cannot have been treated by a podiatrist for another type of foot problem during that six month interval, for instance.

Those attending Medicare-assigned podiatrists are typically on the hook for 20 percent of any permissible charge plus the Medicare Part B deductible. Those seeing specialists in outpatient facilities are responsible for copayments. And those with foot deformities or other injuries are entitled to up to 80 percent of allowable charges, with the patient lined up to pay the remaining 20 percent and any deductible.

Original Medicare, which includes Part A and Part B, does not cover what’s known as “routine” podiatry services, however.

Medicare Advantage Coverage

There are other ways to obtain Medicare benefits, such as through the Medicare Advantage plan. Because these plans have to offer the same coverage as Part A and Part B Medicare services, Medicare Advantage plans may help some additional benefits for diabetics. These include prescription drugs, vision, dental care, and other services like podiatry examinations.

In order to determine what each Medicare Advantage plan covers with respect to diabetes, check the specific details. Plans may vary in terms of regional differences and plan particulars, so it’s always best to confirm coverage before use.

Medicare recipients will still need to pay the Medicare Part B premium, along with deductibles, copayments and any coinsurance.

What Isn’t Covered

As mentioned, “routine” foot care is not covered by Medicare.

Among those procedures not covered, the treatment of so-called “flat feet” is on the list. Routine foot care is also not covered, so long as routine foot care includes corn or callus removal, trimming or cutting of problem toenails, and other pieces of hygienic or preventative maintenance care. This includes cleaning, soaking or applying lotion to the feet – even for those in hospital.

Medicare does also not typically cover orthopedic shoes or other support devices, unless they are part of podiatry emergency care like in the form of a leg brace or the like. There are some exceptions pertaining to diabetic patients, including some types of therapeutic shoes and inserts to help overall foot support.