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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Orthopedic shoes and other supportive devices for the feet generally are not covered. However, this exclusion 
does not apply to such a shoe if it is an integral part of a leg brace, and its expense is included as part of the 
cost of the brace. Also, this exclusion does not apply to therapeutic shoes furnished to diabetics. You can find 
this rule in the Medicare Benefit Policy Manual, Chapter 15, Section 290(3). 
 
The need for diabetic shoes must be certified by a physician who is a doctor of medicine or a doctor of 
osteopathy and who is responsible for diagnosing and treating the patient's diabetic systemic condition through 
a comprehensive plan of care. This managing physician must: 1. Document in the patient's medical record that 
the patient has diabetes; 2. Certify that the patient is being treated under a comprehensive plan of care for 
diabetes, and that the patient needs diabetic shoes; and 3. Document in the patient's  record that the patient has 
one or more of the following conditions: a. Peripheral neuropathy with evidence of callus formation; b. History 
of pre-ulcerative calluses; c. History of previous ulceration; d. Foot deformity; e. Previous amputation of the 
foot or part of the foot; or f. Poor circulation. You can find this information in the Medicare Benefit Policy 
Manual Chapter 15 -140. 
 
The rules say that Shoes are also covered if they are an integral part of a covered leg brace described by codes 
L1900, L1920, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2050, L2060, L2080, or L2090. Oxford 
shoes (L3224, L3225) are covered in these situations. Other shoes, e.g. high top, depth inlay or custom for non-
diabetics, etc. (L3649), are also covered if they are an integral part of a covered brace and if they are medically 
necessary for the proper functioning of the brace. Heel replacements (L3455, L3460), sole replacements 
(L3530, L3540), and shoe transfers (L3600, L3610, L3620, L3630 and L3640) involving shoes on a covered 
brace are also covered. Inserts and other shoe modifications (L3000, L3001, L3002, L3003, L3010, L3020, 
L3030, L3031, L3040, L3050, L3060, L3070, L3080, L3090, L3100, L3140, L3150, L3160, L3170, L3300, 
L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3390, L3400, L3410, L3420, 
L3430, L3440, L3450, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3550, L3560, L3570, L3580, 
L3590 and L3595) are covered if they are on a shoe that is an integral part of a covered brace and if they are 
medically necessary for the proper functioning of the brace. Shoes and related modifications, inserts, heel/sole 
replacements or shoe transfers billed without a KX modifier will be denied as noncovered because coverage is 
statutorily excluded. You can find this information in Medicare's Local Coverage Article: Orthopedic Footwear 
- Policy Article (A52481) 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.