Many patients call asking about Medicare coverage for foot orthotics. Many patients are informed that Medicare would not cover their orthotics. The patients then called Medicare and are told by he person she spoke with that Medicare does cover them.
The short answer is Medicare does not cover foot orthoses.
Custom foot orthoses are billed under HCPCS Code L3000. In some situations they are billed as L3010 and L3020. Here are the Medicare HCPCS codes for foot orthoses.
Medicare HCPCS Codes for Custom Foot Orthoses
L3000: Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each
L3010 Foot, insert, removable, molded to patient model, longitudinal arch support...
L3020 Foot, insert, removable, molded to patient model, longitudinal/ metatarsal ...
Medicare does not pay for these codes and thus does not cover foot orthotics. They are absolutely never a covered service.
Does Medicare Cover Foot Orthotics?
Patients can get confused because they will be told by poorly trained Medicare personnel that foot orthotics are covered. The reason for this is that there is one situation where these codes are paid by Medicare. That situation is when the orthoses is an integral part of a shoe that is attached to a leg brace. That means the brace is attached permanently to the shoe. We are talking about the kind of brace that FDR wore. In the picture at left you can see the braces attached to the shoe under his pant leg. At far left are the actual braces attached to his shoes. So Medicare might pay for foot orthoses IF your patient is wearing these.
The other thing that is confusing to patients (and to some doctors) is that Medicare does cover soft insoles for diabetic patients under the Medicare Therapeutic Shoe Bill. These are not functional orthoses, simply soft accommodative insoles that compress quickly and provide less control then most good prefabricated orthoses.
Here is the HCPCS code for Diabetic Shoe Soft inserts
A5513: For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer or higher), includes arch filler and other shaping material, custom fabricated, each.
Medicare does cover these codes if you meet the criteria.