Orthopedic Footwear

Medicare covers orthopedic footwear only when the item is an eligible Medicare benefit, is reasonable and necessary for diagnosis/treatment or to improve function of a malformed body member, and meets all statutory and regulatory requirements. Prosthetic shoes (HCPCS L3250) are covered only when they are integral to a prosthesis for beneficiaries with partial foot amputation; claims lacking a required SWO/WOPD, correct coding, or proof of delivery will be denied. Additional documentation, ICD-10 coding criteria, and payment rules are defined in the LCD-related Policy and Standard Documentation Requirements Articles and the Supplier Manual.

"An item is covered only if it is an eligible Medicare benefit category, is reasonable and necessary for diagnosis or treatment or to improve functioning of a malformed body member, and meets all Me..."

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