Diabetic Shoes and Inserts - DME.FT.100.A

Therapeutic diabetic shoes (depth A5500 or custom-molded A5501), related inserts and specified modifications are covered for beneficiaries with diabetes who meet high‑risk foot criteria (e.g., deformity, peripheral neuropathy, poor circulation, prior ulceration/amputation, pre‑ulcerative callus) but deluxe features (HCPCS A5508) and any active, untreated plantar foot ulcer are excluded. Coverage requires documentation of diabetes, a physician‑documented foot exam describing abnormalities to be accommodated, ongoing participation in a physician‑directed diabetes management program, certifying provider (MD/DO/NP/PA) involvement (and for custom shoes documentation that deformity cannot be accommodated by depth shoes), and is limited to either one pair of depth shoes + up to three inserts per calendar year or one pair of custom‑molded shoes (includes inserts) + two additional inserts, with insert/modification codes payable only when tied to diabetic shoes.

"A modification of a custom molded or depth shoe may be medically necessary as a substitute for an insert."