Does Medicare Cover Orthopedic Shoes?
There are several types of orthopedic shoes and many types of covered products for leg braces. If they are an integral part of a covered leg brace, Medicare will cover:
- Oxfords
- High tops
- Depth inlays
- Custom shoes for non diabetics
If they are also medically necessary for the proper functioning of the brace, Medicare will cover:
- Heel replacements
- Sole replacements
- Shoe transfers
Patients with partial foot amputations can have their prosthetic shoes covered if they are an integral part of the prosthesis.
Some of restrictions that apply to coverage include:
- All equipment (shoes and related modifications, all inserts, shoe transfers, heel replacements and sole replacements) must be billed with a KX modifier or they will be denied payment as non-covered.
- The billing for the shoe and brace must come from the same supplier.
- In addition to the KX modifier, footwear codes must also be used with the right (RT) and left (LT) modifiers.
- A properly detailed order for the prosthesis must be signed and dated by the treating physician.
- The order for the prosthesis must be kept on file with the supplier in the event in needs to be made available the the DMERC.
Shoes, inserts and modifications for patients with diabetes are covered under Medicare's Diabetic Footwear policy.
How Much Do You Pay?
You pay for 20% of the Medicare approved amount under Medicare Part B.
You must pay a $135 deductible for any Medicare Part B services and supplies before Medicare begins to pay its share. If a doctor, health care provider or supplier does not accept assignment; the amount you pay may be higher. It is extremely important that your supplier is a participating supplier in the Medicare Program. If a supplier of your durable medical equipment (DME) does not accept assignment there is no limit to what you may be charged. You may also have to pay the entire bill (including Medicare's share) at the time you get your DME. |