ORIGINAL MEDICARE
For some, routine footcare include pedicures and foot massages. But for other individuals, like those with Diabetes and Arthritis, routine footcare is more serious, and requires treatment from a podiatrist.
Podiatrists specialize in the treatment of the foot, ankle and lower leg. Most commonly, ingrown toenails, heel spurs, fallen arches, plantar fasciitis and foot/ankle injuries are a common issue treated by these specialists.
Podiatrists also specialize in treatment for individuals with issues related to Diabetes and other systemic medical conditions like Peripheral Arterial Disease (PAD) and Advanced Arterial Ischemia.
Medicare Coverage for Podiatry
Medicare covers medical necessary podiatry care. So what does Medicare consider as medically necessary? Conditions and their treatment options include some of the following:
Hammertoes
Treatment for hammertoes which is a painful condition around the heel bone leading to inflammation in which caused by a muscle imbalance which in turn deforms the toe causing it to look like a, “hammer.”
Treatment includes cortisone injections to decrease the inflammation caused by the painful condition, In some cases your podiatrist can create a shoe insert for cushioning.
Morton’s Neuroma
Morton’s Neuroma which is irritation of the nerves leading to the toes. A common sign of Morton’s Neuroma is numbness and pain. Treatment for Morton’s neuroma includes using a metatarsal pad, cortisone injections and in some cases surgical intervention if the pain persists.
Plantar Fasciitis
Plantar Fasciitis is when the plantar fascia (the thick band of tissue located at the sole) starts to tear causing inflammation which in turn causes severe pain with weight bearing and walking.
Pain is usually the worst in the morning as during the night, while sleeping, the calf and foot muscles automatically tighten up.
Treatment for Plantar Fasciitis includes physical therapy for proper stretching exercises, wearing a night splint, cortisone injections and worse case scenario is surgical intervention.
Bunions
Bunions, which is a bony lump found on the base of the big toe that causes bone deformity, pain and stiffness that can worsen over time. When conservative treatment fails, such as a bunion pad, toe spacer or shoe inserts, surgery may be necessary for pain relief.
Stress Fractures
Stress fractures are caused by repetitive force to a specific area (bone) causing microscopic fractures. Common causes of stress fractures include walking, running, exercising and sports that involve frequent jumping.
Most commonly, stress fractures heal on their own after using crutches or a walking boot. In some severe cases in which the fracture won’t heal due to it being in a complex bone in the foot, surgical intervention will be required for proper healing.
Peripheral Neuropathy
Peripheral Neuropathy is caused by nerve damage. Once damaged, those nerves are no longer able to send the proper messages from the spinal cord and brain to other parts of the body like the muscles and skin.
Most commonly, when Peripheral Neuropathy affects the feet, a person will experience pain, burning sensations, numbness, tingling and weakness. Common causes of Peripheral Neuropathy include:
- Diabetes
- Neurological disorders like Spina Bifida
- An injury to the foot
- Toxin exposure
- Infection
- Autoimmune disease
- Vitamin deficiency
- Chronic alcoholism
There is no known cure for Peripheral Neuropathy so treating the symptoms of the disease is the only option. The most common source of treatment is neuropathic pain medications but also include topical creams, gels and patches. In some cases a cortisone sympathetic nerve block can be done for temporary pain relief.
This is just a portion of conditions and treatment options that a podiatrist specializes in. You can speak with your physician for a complete list of all the conditions and what their treatment options are.
They should also be able to tell you whether or not the treatment plan is considered medically necessary and whether or not Medicare will cover it.
If your treatment is considered as medically necessary, your Medicare Part B benefits will cover 80% of the Medicare allowables. You will be responsible for the Medicare Part B deductible if it has not yet been met before Medicare will pick up coverage.
Additionally, you will be left responsible for the 20% coinsurance not covered by the Part B benefits. There may be a copayment required for some outpatient, hospital-like settings.
When is Podiatry Not Covered by Medicare Benefits
There are a variety of conditions that are not considered medically necessary by Medicare. Routine care is not considered 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
Again, talk with your healthcare provider to find out more information on what is and isn’t covered with your Medicare Part B benefits.
How to Get Additional Podiatry Coverage
With your Medicare benefits only providing 80% coverage of the Medicare approved charges, a Medicare Supplement Plan can provide that extra bit of coverage needed for those unwanted and unnecessary out of pocket costs (OOP).
You can contact us today for more information on supplemental health insurance and we can help pick a policy which will best suits your needs. Call our toll free 800 number or click to fill out our online forms today!
Fun Facts About the Feet
According to a fun article on Foot, here are some fun facts you probably didn’t know:
The foot contains 19 muscles, 107 ligaments, 33 joints, 26 bones and nearly 8,000 nerves. There are 250,000 sweat glands in the feet that produce roughly about ½ a pint of sweat a day.
1/4 of all the bones in the human body belong in the feet and when the bones are out of alignment, the rest of the body will be out of alignment as well.
