OBJECTIVE
Medicare covers extra-depth or custom-molded shoes with inserts for an enrollee with diabetes under the Medical and Other Health Services benefit provided that certain factors are met (e.g., the physician who is managing the enrollee’s diabetic conditions documents the qualifying foot condition and certifies that the enrollee needs such shoes under a comprehensive plan of care related to the enrollee’s diabetic condition) (Social Security Act §1861(s)(12)). For calendar years 2024 and 2025, Medicare paid more than $143 million for therapeutic shoes and inserts. For both years, CMS’s Comprehensive Error Rate Testing program reported high improper payment rates for therapeutic shoes and inserts due to insufficient documentation. Upon request, suppliers must provide documentation that justifies Medicare payments for therapeutic shoes and inserts. We will determine whether Medicare paid suppliers for therapeutic shoes and inserts in accordance with Medicare requirements and guidance.
TIMELINE
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May 29, 2026Announced