TRICARE Prior Authorization for Diabetic Shoes & Inserts | TRICARE.com

*TRICARE.com is an independent reference site and is not the official TRICARE program or the Defense Health Agency. For official policy, please visit TRICARE.mil.*

## Quick answer In most cases, you do not submit a prior authorization yourself; your TRICARE-authorized provider (such as an endocrinologist or podiatrist) submits it to your regional contractor, either **Humana Military** (East) or **TriWest Healthcare Alliance** (West). To qualify, your doctor must document a medical necessity, such as a diagnosis of diabetes mellitus paired with specific foot conditions like peripheral neuropathy or foot deformities.

In detail

TRICARE covers diabetic shoes and inserts as **Durable Medical Equipment (DME)**. However, coverage is highly specific and requires a formal medical evaluation before any equipment is dispensed.

### The Authorization Process 1. **Diagnosis:** A physician (usually a MD or DO) must be managing your systemic diabetes. 2. **Referral & Prescription:** Your physician or a podiatrist must write a prescription stating the specific medical need for "therapeutic shoes and/or inserts." 3. **Medical Documentation:** For 2026, TRICARE requires documentation that the patient has at least one of the following: * Previous amputation of the foot or part of the foot. * History of previous foot ulceration. * Pre-ulcerative calluses. * Peripheral neuropathy with evidence of callus formation. * Foot deformity. * Poor circulation. 4. **Submission:** The provider submits the clinical notes and the authorization request to the regional contractor. * **East Region:** Humana Military * **West Region:** TriWest Healthcare Alliance 5. **Fitting:** Once approved, the shoes must be fitted and furnished by a podiatrist, orthotist, prosthetist, or a pedorthist.

### TRICARE Coverage Limits (2026) TRICARE generally follows Medicare guidelines for quantities. In a single calendar year, coverage is typically limited to: * One pair of custom-molded shoes (including inserts provided with such shoes) and two additional pairs of inserts; OR * One pair of extra-depth shoes and three pairs of inserts.

### Cost-Sharing and Deductibles Costs depend on your plan and sponsor status. As of 2026: * **TRICARE Prime:** $0 copayment for DME if authorized (Active Duty and retirees). * **TRICARE Select (Group A retirees):** 20% of the allowed amount after the deductible is met. * **TRICARE Select (Group B/All Active Duty Families):** 20% of the allowed amount after the annual deductible. * **Point of Service (POS):** If a Prime beneficiary sees a non-network provider without a referral, they may face a 50% cost-share.

## Who this applies to * **Active Duty Service Members (ADSMs):** Require a referral and 100% prior authorization through their military hospital or TRICARE Prime provider. * **Active Duty Family Members (ADFMs):** If using TRICARE Prime, they need authorization. If using TRICARE Select, authorization is recommended but they will pay a 20% cost-share. * **Retirees and Families:** Must meet their annual deductible before TRICARE pays its portion of the DME cost. * **TRICARE For Life (TFL) Users:** TFL acts as secondary payer to Medicare. Since Medicare covers diabetic shoes under Part B, you must follow Medicare’s authorization rules first.

Common scenarios

**Scenario 1: Retiree in the West Region (2026)** An Army retiree on TRICARE Select with diabetic neuropathy needs custom inserts. They visit a network podiatrist in Nevada. The podiatrist sends the request to **TriWest**. Once approved, the inserts cost $400. The retiree has already met their deductible, so they pay a 20% cost-share of **$80**.

**Scenario 2: Active Duty Spouse in the East Region (2026)** A Navy spouse on TRICARE Prime develops a foot deformity due to diabetes. Their PCM sends a referral to a network orthotist. **Humana Military** approves the request. Because the spouse is on Prime and uses a network provider, their out-of-pocket cost is **$0**.

**Scenario 3: TRICARE For Life (TFL) Beneficiary** A 70-year-old veteran has Medicare and TFL. They go to a Medicare-enrolled supplier for diabetic shoes. Medicare pays 80% of the approved amount. TFL automatically pays the remaining 20%. The veteran pays **$0** out of pocket, provided the supplier accepts Medicare assignment.

## Related terms * **Durable Medical Equipment (DME):** Multi-use medical tools (like wheelchairs or specialized shoes) prescribed by a doctor. * **Medical Necessity:** The standard used by TRICARE to determine if a treatment/item is required for the diagnosis or treatment of a condition. * **Pedorthist:** A specialist in using footwear and supportive devices to address conditions which affect the feet and lower limbs. * **Regional Contractor:** The private company (Humana or TriWest) that manages TRICARE benefits in a specific geographic area. * **Certificate of Medical Necessity (CMN):** A form required by insurers that justifies the need for specific medical equipment.

## Sources * **TRICARE.mil Durable Medical Equipment:** https://www.tricare.mil/CoveredServices/IsItCovered/DME * **Humana Military (East Contractor):** https://www.humanamilitary.com/ * **TriWest Healthcare Alliance (West Contractor):** https://www.triwest.com/ * **Medicare.gov Therapeutic Shoes:** https://www.medicare.gov/coverage/therapeutic-shoes-inserts