Routine Foot Care
The following information from Centers of Medicare & Medicaid Services
instructs physicians about Medicare’s requirements for payment of services
for foot and nail care claims.
Routine Foot Care Exclusion:
Except as noted in “Exceptions to Routine Foot Care Exclusion” section, routine foot care is excluded from coverage. Services that are normally considered routine and not covered by Medicare include:
• The cutting or removal of corns and calluses;
• The trimming, cutting, clipping, or debriding of nails; and
• Other hygienic and preventive maintenance care such as cleaning and soaking the foot, use of skin creams to maintain skin tone of either ambulatory or bedfast patients, and any other service performed in the absence of localized illness, injury, or symptoms involving the foot.
Exceptions to Routine Foot Care Exclusion
1. Services performed as a necessary and integral part of otherwise covered services such as diagnosis and treatment of ulcers, wounds, infections, and fractures.
2. The presence of a systemic condition such as metabolic, neurologic, or peripheral vascular disease that may require scrupulous foot care by a professional. Certain procedures that are otherwise considered routine may be covered when systemic condition(s), are demonstrated through physical and/or clinical findings.
3. Services performed for diabetic patients with a documented diagnosis of peripheral neuropathy and loss of protective sensation (LOPS) and no other physical and/or clinical findings sufficient to allow a presumption of coverage as noted in the Medicare Carriers Manual. This class of patients can receive an evaluation and treatment of the feet no more often than every six months.
4. Treatment of warts, including plantar warts, may be covered. Coverage is to the same extent as services provided for in treatment of warts located elsewhere on the body.
5. Treatment of mycotic nails for an ambulatory patient is covered only when the physician attending a patient’s mycotic condition documents in the medical record that (1) there is clinical evidence of mycosis of the toenail and (2) the patient has marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.
If You Have Any Questions or need additional assistance contact your department compliance staff or Neil Walsh at 617-732-9377.