A Guide to Podiatry and Medicare

It’s said that nearly 90 percent of Americans will experience foot pain within their lifetime.
About one-third of people, 65 and older admit to having either stiffness or aches and pains in
their feet.
Some of the most common foot disorders in seniors are bunions, calluses and corns, and
toenail conditions. Painful foot conditions can lead to mobility difficulties, which in turn can
lead to poor overall health.
Because we use our feet to walk, stand, balance, climb stairs, and do other daily activities, it’s
important we take care of them. Who better to see for foot pain than a foot specialist? But
Medicare doesn’t cover all podiatry services.
How Medicare Pays for Podiatry
First, let’s talk about which part of Medicare offers coverage for podiatry services. Because
podiatry is a doctor service usually done in an outpatient setting, Medicare Part B dictates
coverage.
Part B covers medically necessary outpatient services such as doctor services, lab testing, and
chemotherapy. When accessing Part B coverage, you must first meet your Part B annual
deductible. As of 2019, that deductible is $185.
Medicare Part B will pay the majority of your medically necessary outpatient bills at 80 percent.
You will be responsible for the rest unless you have a Medigap plan such as Plan G. Medigap
Plan G covers all of your cost-sharing expenses within Original Medicare but one – your Part B
deductible.
Plan G also covers your Part B excess charges. An excess charge is an up to 15 percent
additional balance on your bill. You incur an excess charge when you see a doctor who doesn’t
accept Medicare assignment. If you don’t have a Medigap plan that covers these excess
charges, be sure to always see providers who accept Medicare assignment.
If you are enrolled in a Medicare Advantage plan instead of Original Medicare, you will still have
access to all the same covered services as Medicare. However, your copay responsibility may be
different so you will want to consult your plan documents to estimate your cost-sharing.
Routine Foot Care is Almost Never Covered
Routine foot care persists of regular hygienic maintenance such as trimming nails and applying
foot cream. Medicare only covers medically necessary services, which these are not. However,
if you have another underlying health condition that affects your feet, Medicare may cover
them.

For example, if you suffer from a systemic condition, such as high blood pressure or diabetes,
that cause circulatory issues in your legs and feet, Part B may cover routine foot treatments
such as corn removal and nail debridement.
Diabetes Patients’ Special Benefits
Because diabetes can cause many foot issues, Medicare will cover extra podiatry services for
beneficiaries who have a confirmed diabetes diagnosis. Medicare will cover a routine foot exam
every six months if you have been diagnosed with diabetes.
However, you can’t have gone to the podiatrist in the meantime for any other reason. For
instance, if you see a podiatrist during the month of May for a Medicare-covered service and
are scheduled for your diabetic foot exam in June, you will have to reschedule your exam for six
months after May.
Medicare will also cover therapeutic shoes and inserts for diabetes patients. There are two
types of therapeutic shoes in this benefit – custom-molded shoes and depth shoes. These shoes
and inserts are billed as durable medical equipment (DME) under Part B. Under this benefit, the
beneficiary is limited to one pair of shoes per year.
To ensure your DME is covered under Part B, your doctor will need to successfully document
the following:
 Your diabetes diagnosis
 You’re being treated for diabetes
 You have at least one type of foot condition
Once the certification for therapeutic shoes has been created, your doctor should send you to a
DME supplier to fill your prescription.
In the end, if you can determine whether your podiatry service is medically necessary, you
should be able to figure out whether Medicare will cover it.

Diabetes &The Foot Part 2: Protecting Your Feet

The following can be done to protect the feet:

Wear shoes that fit well and protect the feet. Athletic or walking shoes are good for daily wear. They support the feet and allow them to “breathe”

Avoid vinyl or plastic shoes, because they don’t stretch or “breathe”

Remember to use sunscreen on the top of your feet if outside

Keep your feet away from radiators and open fires

Do not use hot water bottles on feet

Keep blood flowing to the feet by doing the following:

Keep feet up when sitting

Perform foot exercises

Wiggle toes for 5 minutes, 2 or 3 times a day

Move ankles up and down and in and out

Minimize crossing the legs

Don’t wear tight socks, elastic or rubber bands, or garters around your legs

Don’t smoke as smoking reduces blood flow to the feet

Control blood glucose, blood pressure and cholesterol by eating healthy and exercising regularly

What are considered “appropriate shoes?”

Shoes that are not pointed, or do not have high heels as these put too much pressure on the toes.

Shoes that are deep and wide enough to prevent rubbing.

Shoes that protect your feet from hot and cold. In the winter, lined boots and socks are great for keeping your feet warm at night

 

To book an appointment to discuss any of the symptoms caused by tight shoes, contact us today!

 

Diabetes And The Foot: Part 1

Diabetes Mellitus (DM) is a systemic disease in which blood glucose accumulates in the bloodstream and cannot get into the cells. There are 2 forms of diabetes; Type 1 and Type 2 diabetes. In Type 1 diabetes, a chemical called insulin which regulates blood glucose’s entry into the cells is not produced. Insulin is normally produced by an organ in our body called the pancreas. When the pancreas does not function well, this chemical (insulin) is not produced and blood cannot get into the cells. Therefore, glucose stays in the blood and also spills over into the urine. Type 1 DM is usually genetic.

In Type 2 diabetes, although insulin may be normally produced by the pancreas, the cells remain insensitive to insulin. Therefore, blood glucose cannot get into cells and accumulates in the bloodstream. Type 2 DM is therefore not dependent on insulin production and could be treated with oral medications or a combination of oral medications & insulin.

The effects of longstanding uncontrolled blood glucose can affect vision, kidneys, blood circulation and leave the arms and the legs void of sensation. Specifically as it relates to the foot, diabetes manifests in the following ways:

-Loss of feeling in the feet: Sensory Peripheral Neuropathy
-Dry, cracked heels and skin which provides the chance for a wound to occur, forming an entry portal for bacteria into the body: Autonomic Neuropathy
-Clawing of the toes, resulting in high pressure areas in the toes as it rubs against shoes. Callus at the bottom of the feet can also result as the toes push down on foot bones (metatarsals): Motor Neuropathy
– Blood circulatory problems can also ensue. This problem can cause delayed wound healing in the event that a callus should break down into a wound

So how can individuals with Diabetes take care of the feet?

There are ways in which individuals with Diabetes can take care of their feet to avoid some of these complications as outlined below:

• Make checking feet part of your everyday routine. When checking feet, look out for cuts, sores, red spots, swelling, and infected toenails
• Wash feet every day by using warm (not hot) water. However, do not soak feet because skin will get dry
• Dry feet well. Be sure to dry between the toes
• Keep the skin soft and smooth
• Rub a thin coat of skin lotion or cream. However, do not put lotion or cream between the toes
• Smooth corns and calluses gently
• Check with your foot doctor before using a pumice stone. If you have to use a pumice stone, use it directly after bathing or showering when the skin is soft
• Do not cut corns and calluses
• Do not use razor blades, corn plasters, or liquid corn and callus removers – they can damage the skin
• Trim Toenails regularly with clippers after bathing/showering. Trim the nails straight across and smooth with an emery board or nail file. Do not cut into the corners of the toenail. If toenails are thick or yellowed, or nails curve and grow into the skin, have a foot doctor trim nails instead
• Protect the feet by wearing socks and shoes at all times. Make sure your socks are clean, lightly padded and fit well. Socks that have no seams are best. For shoes, check that there is nothing in the inside of the shoe that could cause damage before putting them on. In addition, check that the lining of the shoe is smooth

If properly done, these steps can help reduce the chances of an ulcer occurring in an individual with Diabetes Mellitus. For further consultation on DM foot, contact us

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