02/04/2015    Mark S. Block, DPM

Medicare Now Paying for Orthotics? (David T. Weiss, DPM)

There continues to be confusion regarding Medicare
coverage for orthotics. I have written and spoken
regarding this subject numerous times locally and
nationally in an attempt to clarify any confusion
that providers may have.

The following is an excerpt from the Medicare
Benefit Policy Manual. I took the liberty of
extracting the significant sections that address
the orthotic issue. In summary, the devices are
not covered unless they meet the following
criteria.

providers should not be misled when payment is
received for services. Payment is not validation
that the services were correctly billed. There
are a number of auditing entities, some of which
are monetarily incentivized to recover payments,
sometimes with penalties, after the fact.

Medicare Benefit Policy Manual
Chapter 15 – Covered Medical and Other Health
Services

Chapter 15, Section 290 of the Medicare Benefit
Policy Manual

E. Supportive Devices for Feet
Orthopedic shoes and other supportive devices for
the feet generally are not covered. However, this
exclusion does not apply to such a shoe if it is
an integral part of a leg brace, and its expense
is included as part of the cost of the brace.
Also, this exclusion does not apply to therapeutic
shoes furnished to diabetics.

…………………………………………

140 - Therapeutic Shoes for Individuals with
Diabetes (Rev. 1, 10-01-03) B3-2134

3. Substitution of Modifications for Inserts
An individual may substitute modification(s) of
custom-molded or depth shoes instead of obtaining
a pair(s) of inserts in any combination. Payment
for the modification(s) may not exceed the limit
set for the inserts for which the individual is
entitled. The following is a list of the most
common shoe modifications available, but it is not
meant as an exhaustive list of the modifications
available for diabetic shoes:

Hopefully this will further clarify the issues.

Mark S. Block, DPM, Boca Raton, FL

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