FootWell
Medicare coverage checklist

Medicare Diabetic Shoes

Use this Medicare therapeutic shoe coverage checker to review the official wording before discussing diabetic foot care with your doctor and supplier. Select your state, then answer the questions using what is documented in your records. Choose "Not sure" when a requirement has not been confirmed. The result summarizes your answers and shows the annual shoe and insert coverage wording and the cost-sharing statement. It is a checklist for your discussion, not a coverage decision or medical advice. The state table below identifies the CMS fee schedule quarter and marks amounts that could not pass the required source verification. Medicare must be billed by an enrolled supplier. Ask the supplier to confirm enrollment and assignment before you get the shoes.

Data as of October 6, 2026

Medicare therapeutic shoe coverage checker

Read each statement and confirm whether it applies. The medical record and supplier documentation matter.

The certifying physician has documented in the patient's medical record 1 or more of these conditions:

Get the items from: A podiatrist, An orthotist, A prosthetist, A pedorthist, Another qualified individual.

A patient's subjective statement about fit doesn't meet this criterion if it's the only documentation of the in-person delivery.

Your checklist

Start with your state

Answer the statements, then select Check my answers.

After you meet the Part B deductible , you pay 20% of the Medicare-approved amount (if your supplier accepts assignment ).

Educational information only. This is not medical advice.

CMS DMEPOS fee schedule by state

Quarter: October 2026. The official CMS ZIP was read and the CSV was parsed. Its compressed contents could not pass the required quote checker, so the amounts are shown as Not verified. No amount is an estimate or your bill.

Requested codes: A5500 (diabetic shoe, per shoe), A5512 and A5513 (inserts). This table uses the non-rural (NR) file columns. Fee amounts are withheld pending verification.

Requested CMS fees, non-rural columns
StateA5500A5512A5513Fee schedule quarter
Alabama (AL)Not verifiedNot verifiedNot verifiedOctober 2026
Alaska (AK)Not verifiedNot verifiedNot verifiedOctober 2026
Arizona (AZ)Not verifiedNot verifiedNot verifiedOctober 2026
Arkansas (AR)Not verifiedNot verifiedNot verifiedOctober 2026
California (CA)Not verifiedNot verifiedNot verifiedOctober 2026
Colorado (CO)Not verifiedNot verifiedNot verifiedOctober 2026
Connecticut (CT)Not verifiedNot verifiedNot verifiedOctober 2026
Delaware (DE)Not verifiedNot verifiedNot verifiedOctober 2026
District of Columbia (DC)Not verifiedNot verifiedNot verifiedOctober 2026
Florida (FL)Not verifiedNot verifiedNot verifiedOctober 2026
Georgia (GA)Not verifiedNot verifiedNot verifiedOctober 2026
Hawaii (HI)Not verifiedNot verifiedNot verifiedOctober 2026
Idaho (ID)Not verifiedNot verifiedNot verifiedOctober 2026
Illinois (IL)Not verifiedNot verifiedNot verifiedOctober 2026
Indiana (IN)Not verifiedNot verifiedNot verifiedOctober 2026
Iowa (IA)Not verifiedNot verifiedNot verifiedOctober 2026
Kansas (KS)Not verifiedNot verifiedNot verifiedOctober 2026
Kentucky (KY)Not verifiedNot verifiedNot verifiedOctober 2026
Louisiana (LA)Not verifiedNot verifiedNot verifiedOctober 2026
Maine (ME)Not verifiedNot verifiedNot verifiedOctober 2026
Maryland (MD)Not verifiedNot verifiedNot verifiedOctober 2026
Massachusetts (MA)Not verifiedNot verifiedNot verifiedOctober 2026
Michigan (MI)Not verifiedNot verifiedNot verifiedOctober 2026
Minnesota (MN)Not verifiedNot verifiedNot verifiedOctober 2026
Mississippi (MS)Not verifiedNot verifiedNot verifiedOctober 2026
Missouri (MO)Not verifiedNot verifiedNot verifiedOctober 2026
Montana (MT)Not verifiedNot verifiedNot verifiedOctober 2026
Nebraska (NE)Not verifiedNot verifiedNot verifiedOctober 2026
Nevada (NV)Not verifiedNot verifiedNot verifiedOctober 2026
New Hampshire (NH)Not verifiedNot verifiedNot verifiedOctober 2026
New Jersey (NJ)Not verifiedNot verifiedNot verifiedOctober 2026
New Mexico (NM)Not verifiedNot verifiedNot verifiedOctober 2026
New York (NY)Not verifiedNot verifiedNot verifiedOctober 2026
North Carolina (NC)Not verifiedNot verifiedNot verifiedOctober 2026
North Dakota (ND)Not verifiedNot verifiedNot verifiedOctober 2026
Ohio (OH)Not verifiedNot verifiedNot verifiedOctober 2026
Oklahoma (OK)Not verifiedNot verifiedNot verifiedOctober 2026
Oregon (OR)Not verifiedNot verifiedNot verifiedOctober 2026
Pennsylvania (PA)Not verifiedNot verifiedNot verifiedOctober 2026
Rhode Island (RI)Not verifiedNot verifiedNot verifiedOctober 2026
South Carolina (SC)Not verifiedNot verifiedNot verifiedOctober 2026
South Dakota (SD)Not verifiedNot verifiedNot verifiedOctober 2026
Tennessee (TN)Not verifiedNot verifiedNot verifiedOctober 2026
Texas (TX)Not verifiedNot verifiedNot verifiedOctober 2026
Utah (UT)Not verifiedNot verifiedNot verifiedOctober 2026
Vermont (VT)Not verifiedNot verifiedNot verifiedOctober 2026
Virginia (VA)Not verifiedNot verifiedNot verifiedOctober 2026
Washington (WA)Not verifiedNot verifiedNot verifiedOctober 2026
West Virginia (WV)Not verifiedNot verifiedNot verifiedOctober 2026
Wisconsin (WI)Not verifiedNot verifiedNot verifiedOctober 2026
Wyoming (WY)Not verifiedNot verifiedNot verifiedOctober 2026

Medicare diabetic shoe questions

Who is eligible for Medicare diabetic shoes?

You have diabetes and severe diabetes-related foot disease. The certifying physician has documented in the patient's medical record 1 or more of these conditions: Previous amputation of the other foot or part of either foot; History of previous foot ulceration of either foot; History of pre-ulcerative calluses of either foot; Peripheral neuropathy with evidence of callus formation of either foot; Deformity of either foot; Poor circulation in either foot.

What is covered each calendar year?

For each patient, we limit coverage of footwear and inserts to 1 of these within 1 calendar year: No more than 1 pair of custom-molded shoes (including inserts provided with them) and 2 more pairs of inserts. No more than 1 pair of depth shoes and 3 pairs of inserts (not including the non-customized removable inserts provided with them).

What do I pay if the supplier accepts assignment?

After you meet the Part B deductible , you pay 20% of the Medicare-approved amount (if your supplier accepts assignment ).

Do the doctor and supplier need to be enrolled?

Medicare will only cover your therapeutic shoes if your doctors and suppliers are enrolled in Medicare. If your doctors or suppliers aren't enrolled, Medicare won't pay the claims they submit.

Is a certification statement enough?

The certification statement isn't sufficient to meet the documentation requirement in the medical record. Have an in-person visit with the patient to discuss diabetes management within 6 months before delivering the shoes or inserts. Sign the certification statement on or after the date of the in-person visit and within 3 months before delivering the shoes or inserts.

Can Medicare cover shoe modifications?

In certain cases, Medicare may also cover separate inserts or shoe modifications instead of inserts.

Sources and verification

Coverage wording: Medicare.gov, Therapeutic shoes & inserts; CMS, Therapeutic Footwear. Fee file: CMS, DME26-D, October 2026 DMEPOS Fee Schedule, DMEPOS_OCT.csv. Amounts marked Not verified are withheld because the required quote checker cannot read the ZIP contents. The quarter is verified on the CMS download page.

When codes are billed without a KX modifier, we deny them as non-covered. Check billing and documentation with your enrolled supplier. This checklist does not approve a claim.

Medicare must be billed by an enrolled supplier. This is not medical advice. Continue with our diabetic foot care guide.

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About FootWell

FootWell is an independent foot-health resource edited by Mustafa Bilgic. Our guides draw on reputable sources including the American Podiatric Medical Association, Mayo Clinic and the NHS. We publish education, not medical advice, always consult a qualified podiatrist or physician for diagnosis and treatment.

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