Medicare and Orthotics/Podiatry
Patients experiencing orthopedic problems such as foot pain, spinal injury, osteoarthritis, back pain, or any other bone or joint condition often need orthotic devices to derive relief from pain and for physical support.
The podiatrist may prescribe orthotic devices to support the healing process following surgeries like knee and hip replacement. The devices are also recommended for patients with injuries such as whiplash.
Doctors may also prescribe orthotics that relieve pain and discomfort by keeping the limb immobile. Orthotics also provide extra support to the muscles and joints that are weak or deformed thereby ensuring a faster recovery.
If your podiatrist has advised you to use an orthotic device, read to find out if the costs of the podiatry services and orthotics are covered by Medicare.
Does Medicare cover orthotics and podiatry?
Podiatrists may prescribe foot orthotics such as a shoe insert to treat foot problems caused due to arthritis, bunions, bursitis, plantar fasciitis, tendinitis, arch or heel pain or diabetic foot ulcers.
Medicare categorizes orthotic devices under the durable medical equipment (DME) benefit. Medicare Part B would cover 80% of the approved costs of orthotic devices when it is recommended by the podiatrist.
The device can be pre-made or custom-made depending on the case. The coverage would be provided only when the podiatrist feels the device is medically necessary to support the recovery of the patient or to avoid further complications.
Durable medical equipment is the device that can be used for healthcare purposes usually at home. These devices have a life expectancy or durability of more than 3 years.
The costs of orthotics would be covered by Medicare part B benefit when it fulfills the criteria for the device to be durable medical equipment. Also, the equipment should not be useful to anyone who is not sick or injured.
Medicare part B has listed the following devices as orthotics under the category of DME:
- Prosthetic devices such as artificial limbs
- Bracing for ankles, back, neck, foot, knee, spine, hand, elbow, and wrist
- Orthopedic shoes when they are a necessary part of the leg brace
- Other prosthetic devices such as artificial eyes
Medicare recipients have to meet all the following prerequisites to be eligible for coverage:
- The orthotic should be medically necessary and the healthcare provider or podiatrist must prescribe it as a part of the complete treatment plan for the management of the condition or injury the patient is diagnosed with.
- The supplier of the orthotic device must be enrolled in Medicare and has to accept Medicare assignment.
Patients who have signed up for Medicare Part B and are eligible for orthotic devices will have to pay 20% of the Medicare-approved cost. It should be noted that Part B deductible would also apply.
Patients are advised to check with their podiatrist as well as the supplier of the orthotic device to ensure they meet the criteria for the fulfillment of the coverage.
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