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Medicare Coverage Guide

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Medicare Coverage Guide

Medicare covers 80% of the products below. Insurance holders pay an annual deductible and the remaining percentage of all expenses. Some individuals may have private insurance to supplement this remaining 20%, making many of these items free of charge for insurance and Medicare holders.

The information listed below is subject to change at any time. Please check directly with Medicare to confirm coverage.

Medical Equipment for Diabetes Covered by Medicare Part B

Item

How often is it covered?

How often is it covered? Necessary documents for coverage

Continuous Glucose Monitors

This is considered durable medical equipment (DME). Amounts and types are based on the prescription. Medicare specifically covers continuous glucose monitors.

This is considered durable medical equipment (DME). Amounts and types are based on the prescription.

Doctor's prescription and proof of purchase or rental from a supplier enrolled with Medicare.

Doctor's prescription and proof of purchase from a supplier enrolled with Medicare.

Note: Insulin is not covered by Part B unless used in an insulin pump. Similarly, Medicare users must pay 100% for insulin pens, syringes, needles, alcohol swabs, and gauze. Non-pump insulin may be covered by Medicare Part D

This is considered durable medical equipment (DME). Amounts and types are based on the prescription.

Doctor's prescription, proof of insulin pump purchase from a supplier enrolled with Medicare, and proof of insulin purchase from a Medicare-approved supplier.

Doctor's prescription and proof of purchase or rental from a supplier enrolled with Medicare.

Therapeutic shoes

One pair of custom-molded shoes and inserts or one pair of extra-depth shoes.

Doctor's prescription, a shoe fitting from a certified professional, and purchase from a supplier enrolled with Medicare (such as Quantum Medical Supply).

Therapeutic shoe inserts

Two (2) pairs of inserts for custom-molded shoes or three (3) pairs of inserts for extra-depth shoes per calendar year.

Doctor's prescription, a shoe fitting from a certified professional, and purchase from a supplier enrolled with Medicare (such as Quantum Medical Supply).

Medical Services for Diabetes Covered by Medicare Part B

Item

How often is it covered?

Necessary documents for coverage

Diabetes self-management training (DSMT)

In year one, Medicare may cover up to 1 hour of individual DSMT and up to 9 hours of group training (10 hours total). In subsequent years, Medicare may cover up to 2 hours of follow-up training per year.

Written order from a doctor or qualified practitioner signifying risk for diabetes complications and proof of supply from an approved DSMT provider.

Eye exam

One exam for diabetic retinopathy per year.

Billing from a doctor legally allowed to conduct this exam in your state.

Glaucoma Tests

One exam every 12 months.

Proof that you are at high risk for glaucoma (this applies to anyone with diabetes) and billing from a doctor legally allowed to conduct this exam in your state.

Medical Nutrition Therapy

Initial nutrition and lifestyle assessment, individual and/or group nutrition therapy services, and follow-up visits as needed.

Referral from your doctor for this service and billing from a Registered Dietitian.

Prescriptions for Diabetes Covered by Medicare Part D

If you have opted into Medicare Part D, your prescription medication for managing diabetes, such as insulin, may be partially or fully covered. It may also cover insulin supplies, such as syringes and gauze.

What Documentation Do I Need?

In most cases, two professionals or companies are involved in the coverage of diabetic services and equipment: The qualifying physician and the supplier.

How to Get Your Diabetic Shoes Covered

First, you will need a Certificate of Medical Necessity (CMN). This is to confirm you need the shoes to be covered by Medicare. This form must be filled out by an MD or DO. Usually, this is your family doctor.

Then, you will need the Shoe Prescription. Typically, your family doctor will fill this out along with the CMN. Other times, a podiatrist or foot professional will complete this document. An MD, DO, NP, or DPM can also sign it.

These two documents can be filled out in any order. For example, your doctor can create a CMN after a nurse practitioner or podiatrist writes you a shoe prescription. If you need help obtaining these documents part, just let us know. Quantum Medical Supply is happy to send a fax or two to confirm your coverage!

Finally, you will need to get shoes from an eligible supplier. We recommend finding a supplier that can directly bill Medicare. You should also look for suppliers that can give you some choice to find the right fit. For example, Quantum Medical Supply provides access to in-home shoe fitting and multiple top diabetic shoe brands.

Direct Billing vs. Applying for Coverage with Medicare

Wherever possible, find suppliers that can directly bill Medicare for you. There are a few reasons this is often the better option:

With direct billing, there is no need to pay costs upfront and wait for an insurance check.
When a doctor or supplier can bill Medicare directly, it proves they are an eligible supplier.
A doctor or supplier who bills directly can educate you on the proper paperwork you need, submitting it directly to insurance to save you time.

Who Qualifies for Medicare Coverage with Diabetic Shoes and Inserts?

Many people with diabetes experience foot issues and will have their shoes and inserts covered by Medicare. Doctors will fill out a Certificate of Medical Necessity for diabetic shoes if a person has a problem such as:

Hammertoes
Bunions
Calluses
Corns

Previous history of ulcerations
Amputations of toes or part of foot
Poor circulation
Neuropathy

If you have diabetes or are experiencing any of these foot complications, Medicare will most likely cover your shoes.

Want to see if Medicare covers your shoes and inserts? Contact us to check your eligibility today!

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