Does Medicare cover peripheral neuropathy treatment?

Yes, Medicare covers medically necessary peripheral neuropathy treatments through multiple parts. Part B covers doctor visits, diagnostic tests like EMGs and nerve conduction studies, physical therapy, occupational therapy, and some pain management procedures. Part D covers neuropathy medications including gabapentin, pregabalin, and duloxetine. Part B also covers certain DME like TENS units, custom orthotics, and therapeutic shoes for diabetic neuropathy. You pay 20% coinsurance for Part B services after meeting the $257 deductible.

What diagnostic tests for neuropathy does Medicare cover?

Medicare Part B covers comprehensive neuropathy diagnostic testing including electromyography (EMG) to assess muscle response, nerve conduction studies (NCS) measuring nerve signal speed, quantitative sensory testing, autonomic function tests, blood tests for underlying causes (diabetes, vitamin deficiencies), skin biopsies for small fiber neuropathy evaluation, and imaging studies when nerve compression is suspected. Coverage requires physician orders documenting medical necessity. You pay 20% of Medicare-approved amounts after your deductible.

Does Medicare cover neuropathy medications?

Medicare Part D covers most neuropathy medications with varying copays by tier. Common covered medications include gabapentin (generic, $0-10 copay), pregabalin/Lyrica (brand, $40-100), duloxetine/Cymbalta (generic available, $5-15), amitriptyline (generic, $0-10), and topical lidocaine patches. Newer drugs like Qutenza patches may require prior authorization. Part B covers certain injectable medications given in medical settings. Coverage depends on your specific Part D plan formulary. Many plans require step therapy, trying generic options before covering brand names.

What is Medicare coverage for diabetic neuropathy specifically?

Medicare provides enhanced coverage for diabetic neuropathy including therapeutic shoes and inserts (one pair annually plus two additional inserts or modifications), comprehensive foot exams every six months, podiatry services for nail and callus care when neuropathy creates risk, diabetes self-management training addressing neuropathy prevention, continuous glucose monitors to prevent progression, and all standard neuropathy treatments. Part B covers 80% of therapeutic shoes after deductible. Documentation of diabetes with neuropathy diagnosis is required for enhanced benefits.

Does Medicare cover physical therapy for peripheral neuropathy?

Medicare Part B covers physical therapy for peripheral neuropathy when ordered by a physician and provided by Medicare-enrolled therapists. Coverage includes evaluation and treatment planning, balance and gait training to prevent falls, strengthening exercises, desensitization techniques, manual therapy, and assistive device training. No specific visit limit exists, but Medicare requires demonstrable improvement or maintenance preventing deterioration. You pay 20% coinsurance after deductible. Therapy caps were eliminated, but claims over $3,000 annually may trigger medical review.

Are TENS units covered by Medicare for neuropathy pain?

Medicare Part B covers TENS (Transcutaneous Electrical Nerve Stimulation) units for chronic neuropathy pain lasting over 3 months. Coverage requires physician prescription, documented trial period showing effectiveness (typically 30-60 days rental), and specific neuropathy diagnosis. Medicare covers 80% of the rental or purchase price after deductible. Initial coverage includes the device, supplies (electrodes, batteries), and replacement supplies. Some Medicare Advantage plans require prior authorization. Documentation must show other treatments tried first.

Does Medicare cover nerve blocks or injections for neuropathy?

Medicare Part B covers medically necessary nerve blocks and injections for neuropathy pain management including epidural steroid injections for nerve root compression, peripheral nerve blocks for localized neuropathy, sympathetic nerve blocks for complex regional pain syndrome, and trigger point injections. Coverage typically allows 3-4 injections per year per site. Medicare covers 80% after deductible when performed in approved facilities. Prior authorization may be required for certain procedures. Documentation must show conservative treatment failure and specific diagnostic criteria.

What DME does Medicare cover for neuropathy patients?

Medicare Part B covers various DME for neuropathy including custom orthotics and shoe modifications, walkers or canes for balance issues, wheelchair if neuropathy severely limits mobility, hospital beds for position changes relieving pain, specialty mattresses preventing pressure ulcers, and compression stockings for certain types. Coverage requires physician prescription documenting medical necessity related to neuropathy. Medicare pays 80% of approved amounts after deductible. Suppliers must be Medicare-enrolled. Some items require prior authorization or specific diagnostic criteria.

Does Medicare cover alternative treatments for neuropathy?

Medicare has limited coverage for alternative neuropathy treatments. Acupuncture is covered for chronic low back pain only, not specifically neuropathy. Chiropractic covers only manual manipulation of spine subluxation. Massage therapy, supplements, and herbal treatments aren't covered. However, Medicare Advantage plans may offer additional benefits like acupuncture, chiropractic expansions, or fitness programs. Some Medicare-covered pain management programs incorporate mindfulness and cognitive behavioral therapy components beneficial for neuropathy patients.

How often does Medicare cover neuropathy monitoring and follow-up?

Medicare covers neuropathy monitoring based on medical necessity without specific frequency limits. Typical covered follow-up includes neurologist visits every 3-6 months for stable neuropathy, more frequent visits during medication adjustments or progression, annual EMG/NCS if clinically indicated, regular lab work monitoring medication side effects, and diabetes monitoring for diabetic neuropathy. Primary care visits for neuropathy management are covered as needed. Documentation must support visit frequency based on symptom severity and treatment response.

What documentation does Medicare require for neuropathy coverage?

Medicare requires comprehensive documentation including confirmed neuropathy diagnosis with ICD-10 codes, diagnostic test results (EMG, NCS, labs), detailed symptoms and functional limitations, failed conservative treatments tried, physician orders with medical necessity explanations, progress notes showing treatment response, and pain scale assessments. For DME, documentation must prove items improve function or activities of daily living. Missing or inadequate documentation is the primary reason for coverage denials. Maintaining detailed records is crucial for continued coverage approval.

Does Medicare Advantage cover neuropathy differently than Original Medicare?

Medicare Advantage must cover everything Original Medicare does but may have different rules including prior authorization for tests, medications, or DME, network restrictions requiring specific providers, step therapy requiring generic medications first, and potentially lower copays for preferred providers. Many MA plans add benefits like expanded physical therapy visits, gym memberships for neuropathy-related exercise, transportation to appointments, and over-the-counter allowances for pain relief items. Review your plan's Evidence of Coverage for specific neuropathy-related benefits and restrictions.

Can Medicare cover pain management programs for neuropathy?

Medicare Part B covers comprehensive outpatient pain management programs for chronic neuropathy when provided by approved facilities. Coverage includes multidisciplinary evaluation, physical therapy components, psychological support and coping strategies, medication management, education about neuropathy, and occupational therapy. Programs typically run 3-4 weeks with daily sessions. Medicare covers 80% after deductible. Some programs offer partial hospitalization for severe cases. Documentation must show failure of conventional single-modality treatments and functional impairment from neuropathy pain.

How can a Solace advocate help with Medicare neuropathy coverage?

Solace neuropathy advocates ensure complete documentation for Medicare requirements, coordinate between multiple specialists (neurologists, pain management, podiatrists), manage prior authorizations for medications and procedures, appeal denied claims with 68% success rate, find Medicare-approved DME suppliers with best prices, navigate Part D formularies for most affordable medications, schedule and track therapy visits to maximize benefits, and identify additional resources like patient assistance programs. Advocates typically save patients $2,000-4,000 annually while improving access to comprehensive neuropathy care through strategic Medicare benefit optimization.

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Medicare Coverage for Peripheral Neuropathy

Medical Reviewer:

Published:

October 9, 2025

8 min read

Key Points

Medicare covers most peripheral neuropathy treatments including doctor visits, diagnostic tests, physical therapy, medications, and medical equipment through Parts A, B, D, and Medicare Advantage plans.
Starting in 2025, Medicare Part D caps your out-of-pocket prescription costs at $2,000 per year—a game-changer for patients taking expensive neuropathy medications.
Medicare covers diabetic neuropathy more generously than other types, including therapeutic shoes, regular foot exams, and enhanced preventive care benefits.
Over half of of Medicare denials get overturned on appeal, but only 11% of patients actually appeal—meaning most people accept denials they could successfully fight.
A Solace chronic pain advocate can handle prior authorizations, appeal denials, coordinate between your doctors, find the best Medicare plan for your needs, and ensure you're getting every benefit you're entitled to.

If you're living with peripheral neuropathy, you already know how overwhelming it can be. The burning, tingling, and numbness are hard enough without trying to figure out what Medicare will and won't pay for. The good news? Medicare actually covers quite a bit—you just need to know where to look and how to access it.

Let's break down exactly what's covered, what you'll pay, and how to get the care you need without breaking the bank.

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What Medicare Covers for Your Neuropathy

Medicare Part B covers most of your outpatient neuropathy care. After you meet your annual deductible of $257 (in 2025), Medicare pays 80% of the approved amount for doctor visits, nerve conduction studies, EMGs, blood tests, and physical therapy. You're responsible for the remaining 20% coinsurance.

Here's what that means in real dollars. If your neurologist visit costs $250, Medicare pays $200 and you pay $50. For a nerve conduction study that costs $650, Medicare covers $520 and you pay $130. These costs can add up quickly, which is why many people choose supplemental insurance.

Physical therapy is especially important for neuropathy patients, and Medicare removed all therapy caps. You can get as much physical therapy as you need, as long as your doctor says it's medically necessary. There's a threshold at $2,410 where Medicare might review your case more closely, but it's not a hard limit—if you need more therapy, you can get it.

Special Benefits for Diabetic Neuropathy

If your neuropathy is caused by diabetes, you get access to extra benefits that other neuropathy patients don't. Medicare covers therapeutic shoes and inserts once per year if you have diabetic peripheral neuropathy with loss of protective sensation. You can get either custom-molded shoes or extra-depth shoes, plus two or three additional pairs of inserts.

Medicare also covers foot exams every six months for people with diabetic neuropathy. This is crucial because neuropathy increases your risk of foot problems that you might not even feel developing. Regular exams catch issues early, before they become serious complications.

The catch? Your doctor needs to document everything properly. Many claims for diabetic shoes get denied simply because the paperwork doesn't clearly show you meet the requirements. This is where having an advocate can make all the difference.

How Medicare Prescription Drug Coverage Changed in 2025

Medicare Part D just underwent its biggest transformation in years. Thanks to the Inflation Reduction Act, starting in 2025, you'll never pay more than $2,000 out-of-pocket for covered medications in a year. Once you hit that cap, your prescriptions are free for the rest of the year.

This is huge for neuropathy patients. Medications like pregabalin (Lyrica) can cost $400-500 per month without assistance. Duloxetine, gabapentin, and other nerve pain medications add up fast. Before this change, patients could face unlimited drug costs. Now, there's finally a ceiling on what you'll pay.

But here's what many people don't realize: different Medicare Part D plans cover different medications at different prices. Gabapentin might be $10 on one plan's formulary but $40 on another. Some plans require you to try cheaper medications first before covering more expensive ones—this is called step therapy, and it can delay getting the medication that actually works for you.

Original Medicare vs. Medicare Advantage: What's the Difference?

You have two main ways to get your Medicare coverage, and the choice matters for neuropathy treatment.

Original Medicare (Parts A and B) lets you see any doctor who accepts Medicare, anywhere in the country. You don't need referrals to see specialists, and there's no prior authorization for most services. The downside? There's no out-of-pocket maximum. Your 20% coinsurance continues all year, no matter how high your medical bills get.

Medicare Advantage plans combine Parts A, B, and usually D into one plan. They have an out-of-pocket maximum—averaging $5,320 in 2025—so your costs are capped. Many plans also include extras like dental, vision, and gym memberships.

But there's a trade-off. Medicare Advantage plans use networks, meaning you might not be able to see your current doctors. Research shows that 99% of Medicare Advantage enrollees are in plans requiring prior authorization for some services. This means waiting for approval before getting an MRI, seeing certain specialists, or starting physical therapy.

Common Coverage Denials and How to Fight Them

Medicare denies neuropathy-related claims for several reasons:

"Not medically necessary" - Often because your doctor didn't document how severe your symptoms are
Missing documentation - The claim lacked proper diagnosis codes or test results
Wrong medication tier - Your drug isn't on the plan's preferred list
Network issues - You saw an out-of-network provider without realizing it

Here's the crucial fact most people don't know: 82% of Medicare appeals succeed, but only 11% of people actually appeal. That means most beneficiaries are accepting denials they could overturn.

The appeals process has five levels, and you don't need a lawyer for the first three. Start by requesting a redetermination (for Original Medicare) or reconsideration (for Medicare Advantage) within 120 days of the denial. Include a letter from your doctor explaining why the treatment is necessary, along with any test results or medical records that support your case.

What Medicare Won't Cover

Understanding what's not covered helps you plan for out-of-pocket expenses. Medicare doesn't pay for:

Laser therapy or infrared devices for neuropathy
Massage therapy (even if your doctor recommends it)
Nutritional supplements like alpha-lipoic acid or B vitamins
CBD products or essential oils
Routine foot care (unless you have diabetes-related nerve damage)

Some Medicare Advantage plans offer limited coverage for acupuncture, but Original Medicare only covers it for chronic low back pain, not neuropathy. Many patients pay $1,000-2,000 annually for these alternative treatments out-of-pocket.

Filling the Coverage Gaps

Medigap supplemental insurance can eliminate most of your out-of-pocket costs. Plan G is the most popular choice—it covers everything except the Part B deductible. With Plan G, that neurologist visit we mentioned earlier? You'd pay nothing after meeting your deductible. The nerve conduction study? Covered completely.

The catch is timing. You have a six-month window when you turn 65 and enroll in Part B to get Medigap without medical underwriting. Miss this window, and insurance companies can deny you coverage or charge higher premiums based on your neuropathy diagnosis.

If you can't afford Medigap, Medicare has programs to help. The Extra Help program can reduce your Part D costs to as little as $0 for premiums and just a few dollars for prescriptions. Medicare Savings Programs can pay your Part B premium and even your deductibles and coinsurance if you qualify based on income.

Tips for Getting the Most from Your Coverage

Success with Medicare coverage comes down to preparation and persistence:

Document everything. Keep records of all your symptoms, how they affect your daily life, and what treatments you've tried. The more evidence you have, the stronger your case for coverage.

Review your plan annually. During Open Enrollment (October 15 - December 7), check if your medications are still covered and compare costs across plans. Using Medicare's Plan Finder tool can save you hundreds or even thousands of dollars per year.

Get prior authorizations in advance. Don't wait until you're at the pharmacy or therapy clinic to find out you need approval. Have your doctor submit authorization requests early, and follow up to ensure they're processed.

Appeal denials immediately. Remember that 82% success rate? You can't win if you don't try. Most appeals at Level 1 and 2 are decided within 30-60 days, and you can continue treatment while waiting for the decision.

How a Solace Advocate Can Help

This is a lot to manage when you're already dealing with neuropathy symptoms. That's where a Solace chronic pain advocate makes all the difference.

Your advocate can review your Medicare options and help you choose the plan that best covers your specific medications and doctors. They'll handle prior authorizations before you need services, not after you're denied. When claims are rejected, they'll manage the entire appeals process—gathering medical records, writing appeal letters, and following up until you get coverage.

Your advocate also coordinates between your various doctors to ensure everyone's on the same page about your treatment. They'll make sure your diabetic neuropathy is properly documented for therapeutic shoe coverage, that your physical therapy is coded correctly to avoid caps, and that you're getting every preventive service you're entitled to.

Most importantly, they'll stay on top of changes like the 2025 Part D improvements, new Medicare Advantage benefits, and shifts in coverage policies that could affect your care. You focus on managing your neuropathy—they'll handle the insurance battles.

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Frequently Asked Questions about Medicare's Neuropathy Coverage

Does Medicare cover all types of neuropathy equally?

‍No, Medicare provides more comprehensive coverage for diabetic peripheral neuropathy than other types. Diabetic neuropathy patients get therapeutic shoes, more frequent foot exams, and enhanced preventive care benefits. Other neuropathy types are covered for treatment but don't qualify for these extra benefits.

How much will I pay out-of-pocket for neuropathy treatment with Original Medicare?

‍With Original Medicare alone, you'll pay 20% of all covered services after meeting your $257 deductible (2025), plus your Part B premium of $185 monthly. Most patients spend $3,000-5,000 annually on premiums, deductibles, coinsurance, and medications. Adding Medigap Plan G typically eliminates all costs except the deductible and premiums.

Can Medicare deny coverage for FDA-approved neuropathy medications?

‍Yes, Medicare Part D plans can require prior authorization, step therapy (trying cheaper drugs first), or may not cover certain medications at all. Each plan has its own formulary. However, you can appeal for an exception if your doctor provides documentation showing why you need that specific medication.

What's the difference between Original Medicare and Medicare Advantage for neuropathy patients?

‍Original Medicare lets you see any doctor who accepts Medicare without referrals, but has no out-of-pocket maximum. Medicare Advantage plans cap your yearly costs (average $5,320 in 2025) and often include extra benefits, but restrict you to network providers and require prior authorizations for many services.

When should I get supplemental insurance for my neuropathy treatment?

During your six-month Medigap Open Enrollment Period when you're 65 or older and enrolled in Part B. This is your only guaranteed chance to get Medigap without medical questions. If you wait until your neuropathy worsens, you may be denied coverage or charged much higher premiums.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

Takeaways

References

CMS: 2025 Medicare Parts A & B Premiums and Deductibles
CMS: Nerve Conduction Studies and Electromyography
CMS: Therapy Services
KFF: Changes to Medicare Part D in 2024 and 2025 Under the Inflation Reduction Act and How Enrollees Will Benefit
KFF: Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization
Medicare: Therapeutic shoes & inserts
Medicare: Foot care (for diabetes)
Medicare: Acupuncture coverage
Medicare: Compare Original Medicare & Medicare Advantage
Medicare: Plan Compare Tool
NCOA: What Are the Steps for Medicare Appeals?

Author

John Taylor, MD

MD, MBA, FACLP

Dr. John Taylor is the Chief Medical Officer at Solace. As a psychiatrist and healthcare leader with deep expertise in behavioral health, dementia care, and population health, he serves as a consultation-liaison psychiatrist at Massachusetts General Hospital and is an assistant professor of psychiatry at Harvard Medical School.

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