Get Your Orthotics Covered By Insurance With These Easy Steps
Your feet may end up costing you thousands of dollars, unless you get your orthotics covered by insurance.


Updated January 22, 2025.

Dealing with foot pain is challenging enough without worrying about the cost of custom orthotics. While these specialized inserts can significantly improve your quality of life, their price tag often causes sticker shock.
The good news? Many insurance plans cover custom orthotics—you just need to know how to navigate the process.
» Stop foot pain from holding you back. Grab your custom-made orthotics
Finding the Right Insurance Coverage
Selecting insurance requires evaluating multiple factors, with orthotic coverage being one crucial element. Insurance providers vary in how they handle durable medical equipment (DME) claims, including orthotics, so check coverage terms, premium costs, and claims processes carefully.
Focus on providers offering transparency in their verification procedures and responsive customer service. Request detailed information about DME coverage policies and prior authorization requirements, as some insurers have specific networks of approved orthotic providers or coverage limitations.
While ideal coverage is important, practical constraints often influence insurance choices. However, to make the most informed decision possible, understand coverage details, annual limits, pre-authorization processes, and documentation requirements before selecting a plan.
» Learn more about the secondary conditions associated with flat feet
How to Get Orthotics Covered by Insurance
If you already have an insurance provider, here's how you can start the process of obtaining coverage for orthotics.
Step 1: Review Your Current Coverage
Contact your insurance provider or review your policy documents to understand your specific coverage for orthotics. Check your annual limits, deductible requirements, and whether you need pre-authorization. Many plans cover custom orthotics under their durable medical equipment (DME) benefits, but coverage levels and requirements vary significantly.
Step 2: Obtain a Medical Diagnosis
Schedule an appointment with your primary care physician or podiatrist to document your condition. Your healthcare provider needs to establish medical necessity through a formal diagnosis, which might include conditions like plantar fasciitis, severe pronation, or complications from injuries. This diagnosis forms the foundation of your insurance claim.
Step 3: Get a Prescription and Documentation
Have your healthcare provider write a detailed prescription for custom orthotics. The prescription should specify why they're medically necessary, including how they'll improve your condition and any relevant medical history.
Ask your provider to include documentation of any conservative treatments you've already tried, as many insurance companies require proof that simpler solutions weren't effective.
» Discover the best insoles for plantar fasciitis-related calf pain
Step 4: Verify Provider Network Status
Confirm that your orthotic provider is in-network with your insurance company. Using an in-network provider typically results in better coverage and lower out-of-pocket costs. If you need to go out-of-network, get written pre-authorization from your insurance company to avoid claim denials.
Step 5: Submit Your Claim Properly
Work with your orthotic provider to submit a clean claim with all required documentation. This typically includes your prescription, diagnosis codes, detailed medical notes, and proof of medical necessity.
Keep copies of everything you submit and maintain a record of all communications with your insurance company, including dates, times, and names of representatives you speak with.
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Orthotics Insurance Coverage Requirements
The following are usually necessary to get your orthotics covered by insurance:
- A diagnosis from a podiatrist or foot care specialist
- A prescription for a custom orthotic from a qualified professional
- A description of the raw materials used to make the orthotics
- Details about the casting method
- A biomechanical gait analysis report
- A list of dates for the foot exam
- The orthotic order date
- A transaction receipt or payment evidence
» Explore the benefits of rigid and soft orthotics for pain relief
Insurance Providers that Cover Custom Orthotics
Many providers consider orthotics as therapeutic medical devices and will reimburse you under certain conditions. Here are some examples:
Aetna
Aetna plans may cover custom shoe inserts prescribed by a doctor to treat a documented medical condition. [1] This means they're deemed medically necessary, not for preventative reasons or general comfort.
Here are some limitations:
- Exclusions: Some Aetna plans might entirely exclude coverage, including shoe inserts.
- Pre-approval: You might need prior authorization from Aetna before getting insoles, especially if they are expensive.
- Copays and Deductibles: Even with coverage, you'll likely have to pay a copay or deductible.
Here's what you can do to get orthotics covered by Aetna:
- Review Your Plan Documents: They will detail your specific coverage for orthotics. You can find them online.
- Contact Aetna: You can also contact Aetna directly at 1-800-872-3862 to confirm your specific plan coverage for orthotic inserts.
- Doctor's Prescription: You'll typically need a doctor's prescription to get Aetna's coverage for orthotics.
Note: The Aetna policy excludes coverage for orthotics purchased on the same date as elective foot surgery. Also, it generally only covers one orthotic per foot, not separate inserts for each pair of shoes.
» Injured yourself while running? Check out the best insoles for shin splints
FSA and HRA
While these aren't precisely insurance providers, the Flexible Spending Account (FSA) and Health Reimbursement Arrangements (HRA) provide full coverage when you pay for custom shoe inserts out of pocket.
You can use the FSA or HRA whenever you buy an insole as long as you have an active account. All you need to do is provide the purchase receipt on request. Plus, the type of orthotic and its price, quality, and material don't matter.
Medicare
On the other hand, Medicare pays for a percentage of the cost. It also comes with limitations, such as:
- It only applies to specific conditions, not all situations where orthotics might be helpful.
- There may be out-of-pocket costs.
- You'll pay 20% of the Medicare-approved amount for covered orthotics after meeting your Part B deductible.
The good news is that Medicare insurance covers a variety of orthotic options under Part B for seniors and young people alike. [2] This includes one pair of custom shoe inserts each year or one pair of extra-depth shoes.
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Tips for Dealing With Denials
Sometimes insurance companies initially deny coverage. Don't get discouraged – denials are common and can often be overcome:
- If your claim is denied, request a written explanation of the denial and review it carefully to understand the specific reason for the denial.
- Work with your healthcare provider to submit an appeal with additional documentation or clarification addressing the specific reasons for denial.
- Consider asking your provider to write a letter of medical necessity that specifically addresses the insurance company's concerns and reinforces why custom orthotics are essential for your condition.
- Keep detailed records of all communications with your insurance company, including dates, names of representatives, and summaries of conversations.
» Avoid the discomfort of ill-fitting orthotics with custom-made solutions
A Simpler Path to Better Foot Health
The path to obtaining insurance coverage for custom orthotics may seem complex, but it's worth it for the sake of your foot health. While insurance claims can involve multiple steps and requirements, alternative payment options can make accessing custom orthotics more straightforward.
Upstep Custom Orthotics is a practical solution that bypasses many common insurance hurdles. Our orthotics are fully FSA/HSA-eligible, so you don't need to worry about complicated approval processes. It's all about convenience—from our easy-to-use home impression kit to our expert customization process.
With Upstep, you can skip the multiple doctor visits and paperwork typically associated with insurance claims, while still getting professional-grade custom orthotics delivered directly to your home.
» Get your custom-made orthotics with FSA/HSA insurance coverage
FAQs
How are foot orthotics billed?
Foot orthotics are billed using a combination of codes depending on the specifics of the service provided.
HCPCS Codes (Level Codes): Identify the specific type of orthotic device provided, such as:
- L3010: Semi-rigid foot orthosis, prefabricated, for increased stability
- L3020: Prefabricated accommodative shoe insert
- L3030: Custom molded foot orthosis
CPT Codes (Evaluation and Management): For evaluation and fitting process performed by the podiatrist or physical therapist. Here are some examples:
- 97760: Initial orthotic fitting and fabrication (with exceeding 8 minutes of training)
- 97761: Subsequent orthotic fitting and fabrication (without exceeding 8 minutes of training)
- 97763: Orthotic device adjustment
What are the signs I need orthotics?
- Foot pain, especially in your heels, arches, or ankles.
- One shoe sole noticeably more worn than the other.
- Frequent stumbles or falls.
- Flat feet or high arches.
How do I get a referral to orthotics?
Referral to podiatrist for orthotics not always required, but check your insurance and consider it for complex cases.
How long do a pair of orthotics last?
Custom orthotics typically last 2-3 years, but it can vary depending on usage and activity level.
What's the average price for foot orthotics?
The average price for foot orthotics varies depending on the type you get. Pre-made cost around $30–100, while custom shoe inserts are $200-800+.
What is the success rate of orthotics?
Studies suggest around 89% success rate for orthotics. [3]
Does insurance cover orthotics?
Many health benefit plans provide partial or complete insurance coverage for specific medical conditions and treatments, including custom shoe inserts. You just need to have a doctor’s prescription.
References:
- A, “Foot Orthotics - Medical Clinical Policy Bulletins | AETNA,” Aetna. Available: https://www.aetna.com/cpb/medical/data/400_499/0451.html
- “Therapeutic shoes & inserts,” Medicare. Available: https://www.medicare.gov/coverage/therapeutic-shoes-inserts
- E. Roos, M. Engström, and B. Söderberg, “Foot orthoses for the treatment of plantar fasciitis,” Foot & Ankle International, vol. 27, no. 8, pp. 606–611, Aug. 2006, doi: 10.1177/107110070602700807. Available: https://pubmed.ncbi.nlm.nih.gov/16919213/
Disclaimer: The information on this blog is for educational purposes only and is not a substitute for professional medical advice.
Upstep does not provide medical diagnosis or treatment. While qualified healthcare professionals create our content, it's essential to consult with your healthcare provider for any foot or ankle concerns you may have.