Medicare coverage for Podiatry is available when it’s medically essential. For some, routine foot care includes pedicures and foot rubs. Although, for people with Diabetes and Arthritis, routine foot care requires a podiatrist.
Podiatrists specialize in the foot, ankle and lower leg. Most commonly, ingrown toenails, heel spurs, fallen arches, plantar fasciitis, and foot/ankle injuries are reasons to see a specialist.
Podiatrists focus on treating people with issues like Diabetes, Peripheral Arterial Disease (PAD), as well as Advanced Arterial Ischemia.
Does Medicare Cover Podiatry
Medically necessary podiatry care has Medicare coverage. So, what is medically necessary?
Conditions and their treatment options include some of the following:
Hammertoes is a painful condition around the heel bone leading to inflammation; inflammation in the muscle imbalances and deforms the toe causing it to look like a “hammer.”
Treatment includes cortisone shots to decrease the inflammation. However, your podiatrist can create a shoe insert for cushioning.
Stress fractures come from continuous force to a specific area causing microscopic fractures. Common causes of stress fractures include walking, running, exercising, and sports that involve constant jumping.
Also, stress fractures heal on their own after using crutches or a walking boot. In some cases the fracture won’t heal due because it’s in a complex bone in the foot; surgical intervention could be a requirement.
Those that need a walking-boot for immobilization treatment after orthopedic surgery or for treatment are eligible. However, those that need a walking boot to relieve pressure or help with ulcers, there is no benefit.
Therapeutic shoes for diabetes ulcer prevention may be available, talk to your doctor.
Plantar Fasciitis is when the plantar fascia starts to tear causing inflammation that causes severe pain with weight-bearing and walking. Pain is usually the worst in the morning.
During the night while sleeping, the calf and foot muscles tighten up. However, treatment for Plantar Fasciitis includes physical therapy for proper stretching exercises, wearing a night splint, cortisone shots, and surgical intervention.
If your podiatry doctor recommends orthotics for Plantar Fasciitis, Medicare coverage isn’t available.
Peripheral Neuropathy is from nerve damage. Once damage occurs, those nerves can’t send messages from the spinal cord and brain to other parts of the body.
Most commonly, when Peripheral Neuropathy affects the feet, a person will feel pain, burning, numbness, tingling, and weakness.
Common causes of Peripheral Neuropathy include:
- Neurological disorders like Spina Bifida
- An injury to the foot
- Toxin exposure
- Autoimmune disease
- Vitamin deficiency
- Chronic alcoholism
There is no cure; however, they can help treat symptoms of the disease. The most common source of treatment is pain pills; however, this can include topical creams, gels, and patches.
A cortisone sympathetic nerve block can be done for short pain relief. Speak with your doctor for a complete list of their treatment options.
Bunions are a bony lump on the big toe that causes bone deformity, pain, and stiffness. When treatment fails, such as a bunion pad, toe spacer or shoe inserts, surgery may be necessary.
If your podiatry doctor does suggest bunion surgery, it’s likely that Medicare coverage is available.
Morton’s Neuroma which is irritation of the nerves leading to the toes. A common sign is a numbness and pain. Also, treatment can include a metatarsal pad, cortisone shots, and surgical intervention.
When is Podiatry Not Covered by Medicare Benefits
There are a variety of conditions that aren’t medically necessary.
Routine care is not medically necessary and some of those treatments include:
- Nail trimming
- Cleaning and soaking of the feet
- Corn and callus removal
- Preventative maintenance
- Flat foot treatment
- Orthopedic shoes and other devices unless it’s an integral brace like an AFO
Does Medicare Cover Podiatry for Ingrown Toenails
Medicare doesn’t usually have coverage for Podiatry services involving toenail clipping and corn/callus removal. However, in special situations, you may have coverage.
If clipping your toenails is hazardous without the help of a doctor, you may have coverage. It’s best to talk to your doctor about the services they advise.
Although, those with diabetes or circulation issues suffering from an ingrown toenail need to seek medical care. A doctor will likely clip the nail and prescribe medicine to treat the infection.
Your doctor may suggest surgery to remove all or a portion of the ingrown nail.
How to Get Additional Medicare Podiatry Coverage
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