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Thursday, June 6, 2019

Medicare and Podiatry

Medicare and Podiatry how are you covered?
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Podiatrists are doctors who specialize in conditions pertaining to feet and ankles. They can treat anything as simple as an ingrown toenail to plantar fasciitis. Aging adults are prone to chronic foot problems, especially if they have an underlying disease such as diabetes.
However, Medicare doesn’t cover all podiatry services. In fact, Medicare doesn’t cover routine foot care at all. For other podiatry services such as treating specific conditions and surgeries, Medicare has specific rules for coverage. First, let’s discuss what isn’t covered by Medicare.

Podiatry Services Not Covered by Medicare

Medicare doesn’t cover routine foot care except in situations where another health condition requires it, such as diabetic neuropathy. Routine foot card includes, but is not limited to, corn removals, debriding toenails, and maintenance care. Another condition that Medicare doesn’t cover any podiatry services for is flat foot.
Medicare also doesn’t cover supportive devices such as orthopedic shoes unless they are included in the price of a leg brace or the patient has diabetes. Medicare doesn’t cover these services because they are not considered medically necessary.

Podiatry Services That May be Covered by Medicare

Medicare will cover podiatry services that are considered needed to diagnose or treat a medical condition. Conditions such as hammer toes, heel spurs, and bunion deformities yield Medicare coverage for treatment.
Diabetes patients get a little more leeway when it comes to foot care because they have a greater risk of developing foot conditions. Therefore, if you have diabetes, you can receive a foot exam once every six months as long as you have been to a podiatrist for any other reason within those six months.
As we briefly mentioned above, Medicare will also cover services that are otherwise considered routine if you have an underlying disease. For instance, if you have peripheral vascular disease, a disease that reduces blood flow to your feet and other limbs, routine podiatry services may be covered. Other diseases and conditions that may validate routine foot care coverage are Buerger’s disease, peripheral neuropathies, and Arteriosclerosis obliterans.
Mycotic nails can be common in the aging community. Mycotic nails are nails that are yellow-brown in color, with a thick and brittle texture, and are usually infected with fungus. Medicare may cover treatment for mycotic nails if your doctor documents clinical evidence of infection, and you are showing symptoms such as pain or secondary infection.

How You’ll Pay for Your Podiatry Services Through Medicare

Podiatry services are usually performed in a doctor’s office in an outpatient setting. Medicare Part B covers medically necessary outpatient doctor services and therefore, will be in charge of your podiatry services.
Part B will pay 80 percent of your medical costs. You will be responsible for both an annual deductible of $185 and 20 percent of the bill. If you receive any treatments in a hospital as an outpatient, you will likely experience a copay as well.
If you ever require surgery to treat a foot condition and you are admitted in the hospital on an in-patient status, Part A will come in effect as well. You will have a $1,364 deductible for your hospital stay that will pay for your hospital services such as your room and meals.
This deductible will also cover your first 20 days in a skilled nursing facility (SNF) if your doctor recommends you finish your recovery there. Medicare will only cover your SNF stay if you were admitted to the hospital for at least 3 days.
When you apply for Medicare, you may want to consider supplemental coverage to help pay for things like this. Medicare plans such as Medigap and Medicare Advantage can help lower some of these costs. Medigap plans can help cover your Part A deductible and Part B deductible, copays, and coinsurance.
Medicare Advantage plans can help lower your out-of-pocket costs by setting a copayment amount that may be lower than your normal Part B coinsurance. Medicare Advantage plans also often offer extra podiatry services, such as routine foot care exams.
In summary, Medicare will cover podiatry services as long as they can be deemed medically necessary. If you’re unsure about whether your specific service will be covered, ask your podiatrist.




2 comments:

  1. Hi Richard,

    I know you aren't taking anymore questions but ill cross my fingers. I'm from SF, currently working abroad. Plan to come back in 2-3 months and should book an appointment. I'm 29, and have always been active - playing basketball, golf, gym, etc.

    Anyway, a year ago, I complained about shin splints. A podiatrist sold me orthotics. Bad ones. They lifted my heel 2 inches off the ground like high heels. They weren't full orthotics, just under the arch. So I was essentially walking on my forefoot all day. I wore them for a while. 2 months go by, and my left achilles ends up in horrible pain. PT tells me the orthotics shortened my achilles, making it tight. So I got PT for 2-3 weeks. Constant massage to fix it. It heals!

    I take those orthotics to a running doc. He customizes them. Shaves off the giant heel, and makes them full length. He did an awesome job. I played basketball in those for months, and was perfectly fine. Only wore them for sports.

    Then 4 months later, I got new shoes - leather boots for nights out. Went traveling for 3 months. I wore them quite a bit walking around at night. They had a wood heel, and wood bottoms with leather. They were nice but not much cushion at all. After walking in them for a while, I started to get a dull sensation under my foot. A small spot. It would go away once I swapped shoes. It wasn't painful, but dull. It would make me limp.

    Anyways, I had no problems when NOT wearing the boots. Then I played basketball one day when I came back from traveling. This sparked my plantar fasciitis. The plantar fasciitis lasted 5 months. It was horrible. I think the plantar fasciitis was my body telling me something was wrong under my foot.

    I got an MRI last year because of the plantar fasciitis, it wasn't for the dull pain. I did tell the Radiologist about the dull pain though. Here are the results: https://imgur.com/Z8bEGv9

    Mind you, this was last year, around this time. The plantar fasciitis is gone! But I have a dull feeling that is constant now under my 3rd metatarsal. It just feels like i'm stepping on something.

    I'm tempted to put myself in a boot for 2 months, and not walk anymore. I'd love to hear if you have any insight. I'd even send you my MRI - although its a year old now. Do you think I should get another one? I've also heard about dye and ulstrasound to be used to find out whats wrong.

    One other additional thing that occurs is - When I haven't taken a step in a long time - say I'm sitting on the couch or something. I get up. I load up my forefoot, as I press off and lift my heel off the ground, there is a snap/crack noise. Maybe 2nd or 3rd metatarsal it sounds like. Its just one metarsal and a click.

    Also, if I am sitting down and flex my toes. My 5th, 4th an 3rd metarsals all make a crackle sound.

    Last year, I taped my entire foot via low dye taping... and told myself i'm not going to let myself crack my metarsals at all. So I limped around, and didn't put any pressure in my foot. I felt great 2 days later. Cracking was gone. But I, I rushed back to the gym and jumping around playing basketball. Went back to the odd 'stepping on something' feeling.

    Anyways, theres a relationship with the crackling/and slight popping in my metarsals. I know the MRI shows plantar plate perforation. Its probably related to that - but my plantar plate feels fine really when touched and pushed with my fingers. I don't have pain - and when I read about others plantar plate tears, its supposed to be painful and have edema. Although my 3rd toe really doesn't have the same strength as my others.

    Overall, its not a throbbing pain! Its dull. Like I'm stepping on something. My 3rd toe is a bit stiff, and doesn't bend the same as all my others btw. When I push the middle phalax from under my toe - its a bit sore. Makes me wonder if it has to do with my toe vs. a plantar plate. Or they are all related.

    Thanks!!

    ReplyDelete
  2. Thanks for emailing. Trying to finish a book on my Inverted orthotic device, so not too organized for the blog right now. I will be. The cracking and popping is common for bursitis around the metatarsal heads. Does not sound like plantar plate due to the lack of pain. Morton's Neuroma can give some of the symptoms you describe, but typically more nerve symptoms like tingling, buzzing, electricity, radiating. Try two weeks of twice daily icing and contrast bathing in the evening to see what symptoms change. Rich

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.