Diabetic shoes might seem like a necessity, and for many patients, they are, but Medicare sees them a bit differently. Many seniors have started receiving denials and are shocked. The problem isn’t that Medicare stopped covering therapeutic shoes. Instead, denials are rising because the documentation rules have become stricter, and even small paperwork errors can void an entire claim.
So, why is Medicare suddenly denying more diabetic shoe claims? Here are seven reasons many patients are receiving now.
1. Medicare Now Requires Detailed Proof of Diabetic Foot Conditions
Medicare covers diabetic shoes only when a patient has diabetes and at least one qualifying foot condition, such as neuropathy, foot deformities, or a history of ulcers. Doctors must document these conditions clearly in their medical notes, not just on a form. If the notes don’t explicitly describe the condition, Medicare considers the claim unsupported.
Many denials occur because the doctor verbally acknowledges the condition but fails to include it in the chart. Seniors can avoid this by confirming their doctor has documented the qualifying condition during their visit.
2. The Certifying Physician Must Manage the Patient’s Diabetes
Your coverage requires that the doctor signing the certification statement be the one who is actively treating the patient’s diabetes. This means a podiatrist cannot sign the form alone. The primary care doctor or endocrinologist must complete it.
If the wrong provider signs, Medicare automatically denies the claim. Many seniors assume the podiatrist handles everything, but Medicare rules make the diabetes‑treating physician responsible for confirming medical necessity. Ensuring the correct doctor signs the paperwork prevents unnecessary denials.
3. Face‑to‑Face Visits Must Occur Within a Strict Time Window
Most of the time, Medicare requires a face‑to‑face visit specifically addressing diabetes management within six months before the shoes are dispensed. If the visit is even one day outside this window, the claim is rejected.
Doctors must document that the visit included a diabetes evaluation, not just a routine check‑in. Many denials happen because the visit notes don’t mention diabetes at all, even if the patient has the condition. Seniors should schedule timely appointments and remind their doctor to document diabetes management during the visit.
4. Medical Notes Must Match the Certification Form Exactly
Auditors compare the doctor’s chart notes to the certification form line by line. If the form says the patient has neuropathy, but the medical notes don’t mention it, the claim is denied. Even minor inconsistencies, such as different dates, missing details, or vague descriptions, can trigger rejection.
Doctors often rely on templates, but Medicare requires individualized notes that reflect the patient’s actual condition. Seniors can request copies of both documents to ensure they match before the supplier submits the claim.
5. Suppliers Must Keep Complete Records
Medicare requires suppliers to maintain a full documentation packet, including the doctor’s notes, certification statement, and proof of the face‑to‑face visit. If any piece is missing, Medicare denies the claim and may even audit the supplier.
Many seniors don’t realize that suppliers, not doctors, are responsible for assembling the final packet. When suppliers fail to collect all required documents, the patient is the one who loses coverage. Asking the supplier to confirm the packet is complete can prevent avoidable denials.
6. Medicare Requires Proof That Shoes Were Fitted and Dispensed Properly
Medicare mandates documentation showing that the shoes were fitted, adjusted, and delivered to the patient. This includes signed delivery receipts and notes from the fitter. If the supplier cannot prove the shoes were dispensed correctly, Medicare may deny the claim even if all medical documentation is perfect.
Seniors sometimes forget to sign delivery forms or lose paperwork, which can cause problems later. Keeping copies of all fitting and delivery documents helps protect coverage.
7. Annual Renewals Require Fresh Documentation
Medicare does not allow diabetic shoe documentation to roll over from year to year. Every year, seniors must have a new face‑to‑face visit, new medical notes, and a new certification form. Many denials occur because patients or doctors assume last year’s paperwork is still valid.
Medicare treats each year as a brand‑new claim with no exceptions. Seniors should mark their calendars to start the renewal process early to avoid gaps in coverage.
Getting Ahead of Medicare’s Documentation Rules
Medicare’s diabetic shoe coverage hasn’t gone away, but the documentation requirements have become far more demanding. Seniors who understand what Medicare expects can work with their doctors and suppliers to ensure every detail is correct before the claim is submitted. A few proactive steps can prevent months of delays, unexpected bills, and unnecessary denials. Staying informed is the best way to protect this important benefit and maintain foot health.
Have you or a loved one experienced a diabetic shoe denial? Share your story in the comments.
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Drew Blankenship is a seasoned automotive professional with over 20 years of hands-on experience as a Porsche technician. While Drew mostly writes about automotives, he also channels his knowledge into writing about money, technology and relationships. Based in North Carolina, Drew still fuels his passion for motorsport by following Formula 1 and spending weekends under the hood when he can. He lives with his wife and two children, who occasionally remind him to take a break from rebuilding engines.
