Understand the Medicare Therapeutic Shoes Pathway Before Your Next Appointment
If you have diabetes and foot problems, Medicare may help cover therapeutic shoes or inserts when certain requirements are met. This guide explains the process in plain English and helps you prepare for a conversation with your doctor, podiatrist, pedorthist or footwear professional.
First, a quick and important note
Pedors does not decide whether Medicare will cover your shoes, and this page is not medical, insurance or billing advice. Medicare therapeutic footwear decisions involve your healthcare providers, documentation and a qualified supplier.
What is the Medicare Therapeutic Shoes Program?
Medicare Part B may cover therapeutic shoes and inserts for some people with diabetes and severe diabetes-related foot disease. This is commonly referred to as the Therapeutic Shoes for Persons with Diabetes benefit, or TSD.
In plain English, this benefit exists because properly selected and properly fitted footwear may be an important part of foot protection for certain people with diabetes.
It starts with diabetes care
The doctor treating your diabetes must be involved and must certify the need when Medicare requirements are met.
A qualified professional orders
A podiatrist or other qualified doctor may prescribe the shoes and inserts.
They must be fitted and supplied properly
A qualified person, such as a podiatrist, pedorthist, orthotist or prosthetist, may be involved in fitting and providing them.
Who may qualify?
Medicare coverage depends on meeting specific requirements. In general, the pathway involves diabetes plus certain diabetes-related foot conditions, proper documentation, a prescription, fitting and supply by qualified professionals.
Topics your healthcare professional may consider include:
- Diabetes diagnosis and ongoing diabetes care
- History of foot ulceration or pre-ulcerative callus
- Peripheral neuropathy with evidence of callus formation
- Foot deformity
- Poor circulation
- History of partial or complete foot amputation
- Whether depth shoes, inserts, modifications or other footwear options are appropriate
How the Medicare therapeutic shoe pathway usually works
The exact process can vary, but the general pathway often looks like this:
Start with the doctor treating your diabetes
Your diabetes-treating doctor is central to the process because certification is required when Medicare coverage is being considered.
Discuss your feet, footwear problems and risk factors
Bring up swelling, pressure areas, calluses, difficulty fitting shoes, foot shape changes, inserts, wounds, previous ulcers or other concerns.
A qualified professional may prescribe therapeutic shoes or inserts
This may involve a podiatrist or other qualified doctor, depending on your care pathway.
The shoes must be fitted and supplied correctly
Fit matters. A qualified supplier or footwear professional may need to assess, fit, verify and provide the footwear.
Documentation matters
Medicare therapeutic footwear has documentation requirements. This is one reason it helps to speak with your healthcare team before assuming coverage.
Medicare coding and PDAC information
Many Pedors styles have been reviewed by the Pricing, Data Analysis and Coding contractor, commonly known as PDAC, and assigned therapeutic footwear billing codes used within the Medicare Therapeutic Shoes for Persons with Diabetes program.
Pedors PDAC coding letters
These PDAC letters are provided as a helpful resource for healthcare professionals, suppliers and patients who want to discuss Pedors footwear in the context of Medicare therapeutic footwear.
PDAC coding does not mean every person qualifies for Medicare coverage, and it does not guarantee payment in any individual case. Coverage depends on Medicare requirements, documentation, practitioner involvement, supplier requirements and the individual patient situation.
Why Pedors may be worth discussing
Pedors shoes are designed for people who struggle to fit comfortably into ordinary footwear. Many Pedors styles feature stretch uppers, extra depth, soft linings and a wide range of widths, including very wide options.
For hard-to-fit feet
Pedors may be helpful to discuss when ordinary shoes feel too tight, create pressure points, or do not accommodate swelling or forefoot width.
For extra width and depth needs
Pedors offers many styles in extra-wide widths, with selected styles available up to 5X-Wide, 10E.
For sensitive feet
Soft, stretchable uppers may help reduce rubbing and make the shoe easier to accommodate throughout the day.
For practitioner conversations
The Pedors catalog can help your doctor, podiatrist, pedorthist or footwear professional see the available styles, widths and fit options.
What to discuss at your next appointment
This page cannot tell you whether you qualify, but it can help you prepare better questions.
- Do I meet the Medicare requirements for therapeutic shoes or inserts?
- Do I have diabetes-related foot findings that should be documented?
- Would depth shoes, inserts, shoe modifications or another option be appropriate?
- Who should prescribe the shoes and inserts?
- Who should fit and supply them?
- Can I bring the Pedors catalog so we can discuss whether these styles are suitable?
- If Pedors is suitable, how should the order be placed?
Common professionals involved in diabetic foot care
Different people may be involved depending on your situation, coverage and local care network.
Primary care doctor
Often involved in diabetes care and referrals.
Doctor treating diabetes
Central to certification when Medicare therapeutic footwear coverage is being considered.
Podiatrist
May assess foot structure, pressure areas, calluses, ulcers, risk factors and footwear needs.
Wound care specialist
May be involved when wounds, ulcers or higher-risk feet are part of the picture.
Pedorthist
May help with footwear fitting, depth shoes, inserts and modifications.
Orthotist or prosthetist
May be involved when orthotic, prosthetic or more complex fitting needs exist.
Request a Free Therapeutic Footwear Information Catalog
The Pedors catalog can help you and your healthcare professional review styles, widths, stretch uppers and fit options. Bring it to your next appointment and ask whether Pedors may be suitable for your feet and your care pathway.
Request Your Free CatalogLooking for diabetic shoes to buy directly?
Not everyone is using the Medicare therapeutic shoe pathway. Some customers simply want comfortable, extra-wide shoes they can buy directly.
Diabetic Shoes for Women
Browse Pedors styles often chosen by women looking for soft, comfortable, extra-wide footwear.
Diabetic Shoes for Men
Browse Pedors styles often chosen by men looking for stretch uppers, extra depth and wider widths.
Pedors width-first fitting philosophy
Many people shop for shoes by length first. At Pedors, we often encourage customers with hard-to-fit feet to think about width and volume too.
Length
The shoe should be long enough without crowding the toes.
Width
The shoe should not pinch across the forefoot or create uncomfortable pressure.
Volume
Depth, swelling, inserts and foot shape all affect how a shoe fits.
Frequently asked questions (tap questions to reveal answers)
Does Medicare cover diabetic shoes?
Medicare Part B may cover therapeutic shoes or inserts for some people with diabetes and severe diabetes-related foot disease when specific requirements are met. Your healthcare providers and qualified supplier must determine whether the requirements are satisfied.
Does having diabetes automatically qualify me?
No. Diabetes alone does not automatically mean therapeutic shoes are covered. The process usually involves diabetes-related foot findings, documentation, certification, prescription, fitting and supply requirements.
Can Pedors tell me if I qualify?
No. Pedors cannot determine Medicare eligibility or coverage for you. This guide is intended to help you understand the pathway and prepare for a conversation with your healthcare professional.
Are Pedors shoes Medicare-approved?
We avoid the phrase “Medicare-approved shoes” because it can be misleading. Many Pedors styles have been reviewed by PDAC and assigned therapeutic footwear billing codes used within the Medicare TSD program. Coverage for any individual depends on Medicare requirements, documentation, practitioner involvement, supplier requirements and the individual situation.
Who should I talk to first?
A good starting point is the doctor who treats your diabetes. You may also discuss your feet with your podiatrist, wound care specialist, pedorthist or other qualified footwear professional.
Can I bring a Pedors catalog to my appointment?
Yes. That is exactly why we offer the catalog. You can bring it to your appointment and ask whether any Pedors styles may be suitable for your feet and care pathway.
What if I am not using Medicare?
You can still buy Pedors shoes directly from Pedors.com. Many customers choose Pedors because they need extra width, extra depth, stretch uppers, soft comfort and easier fitting.
A simple sentence to use with your healthcare professional
Ready to take the next step?
Request your free Pedors catalog, bring it to your next appointment, and ask your healthcare professional whether Pedors may be a good fit for your needs.
Request Your Free CatalogDisclaimer: This page is for general educational purposes only and is not medical, legal, billing or insurance advice. Medicare coverage depends on current Medicare rules, documentation, practitioner involvement, supplier requirements and your individual situation. Please consult your healthcare professional and Medicare-enrolled supplier for guidance.