Medicare Podiatry Coverage: What Part B Pays for Foot Care

Medicare Part B pays for a podiatrist when you have a foot injury or disease that needs treatment: a bunion, a hammer toe, a heel spur, an infected ingrown toenail, an ulcer. It does not pay for routine foot care like trimming nails or shaving calluses, unless a condition such as diabetes or poor circulation makes that care risky for anyone but a professional. For covered care you pay 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026.

That line between "treatment" and "routine" decides most podiatry bills. It isn't about which doctor you see. A podiatrist is paid, within the scope of their license, for anything Medicare would cover from an MD, and a medical doctor gets denied for routine nail trimming just like a podiatrist would. What matters is the service and what your medical record says about your feet.

Source: Medicare.gov, Foot care; CMS 2026 Parts A and B fact sheet; Medicare.gov, Foot care for diabetes; Medicare.gov, Therapeutic shoes and inserts.

CMS hadn't announced the 2027 Part B deductible as of November 15, 2026. The coverage rules below don't change with it; I'll update the dollar figures when CMS publishes them.

What Part B covers and what it doesn't

Under 42 CFR 410.25, Part B pays for a doctor of podiatric medicine acting within the scope of their license whenever the service would be covered as a physician's service from a doctor of medicine or osteopathy. So the question is never "does Medicare cover podiatrists?" It does. The question is whether the specific service is covered.

Medicare.gov's foot care page names hammer toe, bunion deformities and heel spurs as examples of foot injuries and diseases Part B treats. The exclusions come from 42 CFR 411.15(l) and section 290 of the Medicare Benefit Policy Manual, chapter 15.

Source: Medicare.gov, Foot care; 42 CFR 411.15(f) and (l); Medicare Benefit Policy Manual ch. 15, sec. 290; NCD 70.2.1.

One detail that surprises people: one bill can be partly covered. The manual's own example is surgery for an ingrown toenail on the same visit as callus removal that wasn't needed for the toe surgery. The surgery gets paid; the callus charge gets denied. Going the other way, if a podiatrist has to trim your toenails to put a cast on a broken foot, Medicare doesn't carve out the trimming. It's part of the covered procedure.

And if you come in with a specific symptom, like pain or swelling, the initial diagnostic visit can be covered even if the answer turns out to be something Medicare won't treat (411.15(l)(2)).

When routine foot care is covered

Routine foot care is excluded by statute, section 1862(a)(13) of the Social Security Act, which CMS lists among its "categorical denials" in the Claims Processing Manual, chapter 30. But the exclusion has exceptions, and they matter most to people with diabetes, circulation problems or nerve damage.

The logic in section 290 of the manual: a systemic condition like metabolic, neurologic or peripheral vascular disease can make nail trimming or callus care hazardous if someone without training does it. When the condition causes severe circulatory problems or areas of diminished sensation in the legs or feet, that otherwise-routine care may be covered.

Source: Medicare Benefit Policy Manual ch. 15, sec. 290 C, D and F; 42 CFR 411.15(l)(2).

A diagnosis on its own isn't enough. The manual says "the mere statement of a diagnosis" doesn't show severity, and claims "should not be paid in the absence of convincing evidence" that non-professional care would have been hazardous. To make that call, reviewers use a presumption based on physical findings the podiatrist records:

Source: Medicare Benefit Policy Manual ch. 15, sec. 290 F.

Practical move: if you've been getting nail care covered because of diabetes or circulation problems, keep your regular visits with the doctor who manages that condition. The podiatrist's claim has to carry that doctor's name and, where active care is required, roughly when you last saw them. A lapse in those visits is one of the easiest ways for this coverage to fall apart.

Why podiatry claims get denied so often

Medicare watches this area closely. CMS's podiatry compliance tip puts the 2024 improper payment rate for podiatry care at 11.2%, about $216.9 million. An HHS Office of Inspector General audit issued in December 2025 (A-09-22-03011) looked at 100 sampled podiatrist claims for routine foot care tied to a systemic condition and found 49 didn't meet Medicare requirements. OIG estimated $4.4 million of the $18.2 million paid in 2019 and 2020 didn't comply.

Insufficient documentation76.4%Incorrect coding11.5%No documentation7.2%Medical necessity4.4%Other0.6%

Source: CMS MLN, Podiatry Care compliance tip (2024 improper payment data).

Show the numbers

Reason	Share
Insufficient documentation	76.4%
Incorrect coding	11.5%
No documentation	7.2%
Medical necessity	4.4%
Other	0.6%

Three-quarters of the problem is paperwork. That's the provider's problem first, but it lands on you when a claim is denied after the fact. If your routine foot care is being billed under one of the exceptions, it's fair to ask the office: which condition is this billed under, and is my primary doctor's information on the claim?

Diabetes: foot exams every six months

If you have diabetic peripheral neuropathy with loss of protective sensation (LOPS), Part B covers a foot exam and treatment every 6 months, as long as you haven't seen a foot care professional for another reason in between, per Medicare.gov. The treatment can include care of foot ulcers and calluses and toenail management.

The national coverage decision behind this, NCD 70.2.1, calls peripheral neuropathy the most common factor leading to amputation in people with diabetes. It also spells out how LOPS is diagnosed: a 5.07 Semmes-Weinstein monofilament touched to five sites on the sole of each foot, and you have to fail to feel it at two or more sites on either foot. That has to be documented before the coverage applies. The exam itself includes a history, a look at the forefoot, heel and between the toes, checks of sensation, foot structure, circulation and skin, an evaluation of whether you need special footwear, and education.

This is different from the yearly wellness visit and the screenings in Medicare preventive services. It's a covered physician service, so the Part B deductible and 20% coinsurance apply.

Therapeutic shoes and inserts

Medicare generally doesn't pay for orthopedic shoes. The exception is therapeutic shoes for people with diabetes and severe diabetes-related foot disease. Section 140 of the Benefit Policy Manual treats them as their own Part B benefit (not durable medical equipment), and it covers a pair even if only one foot has the disease.

Source: Medicare.gov, Therapeutic shoes and inserts; Medicare Benefit Policy Manual ch. 15, sec. 140. Custom-molded shoes (with the inserts that come with them) are for people who can't wear depth shoes because of a foot deformity. Shoe modifications such as rocker bottoms, metatarsal bars or wedges can be substituted for inserts, up to the insert payment limit.

Getting them takes three steps, in order:

1. The doctor managing your diabetes (an MD or DO) certifies that you have diabetes, that you're treated under a comprehensive diabetes care plan and need the shoes, and documents at least one of these: peripheral neuropathy with callus formation, a history of pre-ulcerative calluses, a history of ulcers, a foot deformity, a past amputation of all or part of a foot, or poor circulation.
2. A podiatrist or other qualified doctor prescribes the type of footwear.
3. A podiatrist, pedorthist, orthotist or prosthetist fits and supplies them.

Medicare pays only if the doctors and the supplier are enrolled in Medicare. Ask the supplier whether it's a participating supplier before you order. A participating supplier must accept assignment and can only charge your deductible and 20% coinsurance; one that doesn't accept assignment has no limit on what it can charge, according to Medicare.gov. More on glucose monitors, test strips and insulin is in my post on Medicare diabetes supplies coverage.

What you pay

For covered foot care, you pay the Part B deductible if you haven't met it yet this year, then 20% of the Medicare-approved amount. If you're treated in a hospital outpatient department, you also owe a copayment (Medicare.gov). For care Medicare doesn't cover, like routine nail trimming with no exception, you pay all of it.

Hypothetical example (the $400 is made up to show the math, not a real Medicare rate): say a podiatrist treats an infected ingrown toenail in the office, and the Medicare-approved amount is $400.

• You pay
• Medicare pays

$0$100$200$300$400

Deductible already met$283 deductible not met

Source: Math based on the 20% coinsurance (Medicare.gov) and $283 deductible (CMS); the $400 approved amount is hypothetical.

Show the numbers

	You pay	Medicare pays
Deductible already met	$80	$320
$283 deductible not met	$306	$94

With the deductible already met, you'd owe $80 and Medicare would pay $320. If it's your first Part B service of 2026, you'd pay the $283 deductible plus 20% of the remaining $117, which comes to $306.40, and Medicare would pay $93.60.

The ABN: when the office asks you to sign

An Advance Beneficiary Notice of Noncoverage (ABN) is the form a provider uses in Original Medicare to warn you that Medicare may not pay. For foot care, there are two different situations, and the Claims Processing Manual, chapter 30 treats them differently:

• Routine care that's never covered. Because routine foot care is excluded by law, the office doesn't need an ABN to bill you for it (section 50.2.1). CMS strongly encourages offices to hand you one anyway as a courtesy, but in that case you shouldn't be asked to check an option box or sign.
• Care that might be denied as not medically necessary. If the office thinks Medicare may decide a normally covered service isn't reasonable and necessary for you (say, more frequent treatment than the rules allow), it has to give you an ABN before the service to be able to bill you if Medicare denies it (section 50.2).

With an ABN in hand, you always have the right to ask the office to send a claim to Medicare for an official payment decision. To do that, you get the service and check Option 1 on the form (section 50.17). If you think the care should be covered, that's the box to pick, because a Medicare denial is something you can appeal. ABNs aren't used in Medicare Advantage (section 50.1).

Medicare Advantage and Medigap

Medicare Advantage. Federal rules require a Medicare Advantage plan to cover all the services Original Medicare Part A and Part B cover and to follow CMS's national coverage determinations (42 CFR 422.101). So covered podiatry, the diabetic foot exam and therapeutic shoes are all in the floor. What differs is how you get them: networks, referrals, prior authorization and cost sharing are set by each plan. Check your plan's Evidence of Coverage before a procedure, and ask whether the podiatrist is in network.

Medigap. A Medicare Supplement policy works off Original Medicare's decision. If Medicare approves the podiatry claim, the 20% is Part B coinsurance, and the standardized plan letter decides how much the policy picks up. If Medicare denies it as routine care, Medigap doesn't step in. Using the $80 coinsurance from the example above:

Source: Medicare.gov, Compare Medigap plan benefits. Only Plans C and F also pay the Part B deductible, and not everyone can buy them; eligibility depends on when you first became eligible for Medicare.

For how Medigap policies work in Washington, see Medicare Supplement plans in Washington and Medicare Supplement insurance in Washington.

If Medicare denies the claim

A denied foot care claim shows up on your Medicare Summary Notice. You have 120 days from receiving it to ask for a redetermination, the first of five appeal levels (42 CFR 405.942). Medicare presumes you got the notice 5 days after its date. You can file with the redetermination form or by circling the item on your MSN and explaining why you disagree, and the contractor generally decides within 60 days (Medicare.gov).

What helps a podiatry appeal is the medical record, not a general statement of your diagnosis:

1. For routine care billed under a systemic condition, a note from the doctor who manages that condition, and the podiatrist's documented findings (pulses, skin and nail changes, sensation testing).
2. For a diabetic foot exam, documentation of the monofilament test showing loss of protective sensation.
3. For fungal nails, the doctor's notes on pain, infection or trouble walking.
4. For shoes, a copy of the certifying doctor's statement and the qualifying foot condition.

The full process is in my post on the Medicare appeal process.

Help in Washington

For an unbiased second opinion on a foot care bill, an ABN or an appeal, Washington's Statewide Health Insurance Benefits Advisors (SHIBA) program at the Office of the Insurance Commissioner offers free Medicare counseling. Call the Insurance Consumer Hotline at 800-562-6900 (8:30 a.m. to 4:30 p.m., Monday through Friday) and ask for your local SHIBA office, or use the SHIBA contact form. Here's how SHIBA works. You can also call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. My general overview of Medicare in Washington covers the rest of the program.

Your own coverage documents and Medicare's rules control how any claim is decided. Confirm your situation with a licensed agent, SHIBA, 1-800-MEDICARE or, for legal questions, an attorney.

Sources

1. Medicare.gov: Foot care
2. Medicare.gov: Foot care (for diabetes)
3. Medicare.gov: Therapeutic shoes & inserts
4. CMS: Medicare Benefit Policy Manual, Chapter 15 (sec. 140 Therapeutic Shoes; sec. 290 Foot Care)
5. CMS: National Coverage Determinations Manual, Chapter 1, Part 1 (NCD 70.2.1)
6. CMS: Medicare Claims Processing Manual, Chapter 30, Financial Liability Protections
7. eCFR: 42 CFR 411.15, Particular services excluded from coverage
8. eCFR: 42 CFR 410.25, Limitations on services of a podiatrist
9. eCFR: 42 CFR 422.101, Requirements relating to basic benefits (Medicare Advantage)
10. eCFR: 42 CFR 405.942, Time frame for filing a redetermination
11. CMS: 2026 Medicare Parts A & B Premiums and Deductibles fact sheet
12. HHS OIG: Podiatrists' Claims for Routine Foot Care Services Did Not Comply With Medicare Requirements (A-09-22-03011)
13. CMS MLN: Podiatry Care, Medicare provider compliance tip
14. Medicare.gov: Compare Medigap plan benefits
15. Medicare.gov: Appeals in Original Medicare
16. Washington OIC: Statewide Health Insurance Benefits Advisors (SHIBA)