Routine Foot Care

Payable and Non-payable Scenarios

By Ramya Vincent, CPC

Routine foot care, regardless of the provider rendering the service, includes care for corns and calluses, nails, dermatomes, simple palliative treatments and other hygienic and preventive maintenance care. The trick is determining whether your insurer will reimburse you for these services, and if so, which diagnoses support medical necessity.

The codes for these procedures are 11055-11057, 11719-11721 and G0127.

Medicare does not consider routine foot care codes payable for healthy patients, but other non-routine foot care procedures, such as those for ulcers, wounds, warts and fungal infections, are covered for otherwise healthy patients by Medicare, assuming the provider documents the services properly.

Medicare allows payment for routine foot care only when the patient is diagnosed with diabetes, chronic thrombophlebitis, arteriosclerosis of extremities, or sensory neuropathies necessitating the need for these services. Medicare pays for treatment of superficial wounds, cutting or removal of corns and calluses and trimming of toenails for diabetic patients and patients with sensory neuropathies.

Medicaid does not recognize routine care for payment unless the patient has a secondary systemic condition diagnosis and is under the active care of a doctor. Append the appropriate Q modifier to identify covered foot care services. The modifiers are Q7 to reflect one class A finding, Q8 to describe two class B findings, Q9 to reflect one class B and two Class C findings. Class findings can be found on page 230 of the Pub 100 CMS document online.

Covered primary diagnoses for most insurers include:

110.1 Dermatophytosis of nail

700 Corns and callosities

703.8 Other specified diseases of nail

250.xx Diabetes mellitus

Documentation requirements that you’ll need to meet to collect for routine foot care services are:

  • Systemic conditions such as diabetes, arterioscelerosis, peripheral vascular disease (PVD), etc., documented by the physician in the chart.
  • Providing “Q” class findings based on the symptoms and signs exhibited in the patient due to these systemic conditions.

Other diagnoses such as multiple sclerosis, quadriplegia, paraplegia, monoplegia, neuropathy, etc. do not require the Q modifier.

Be Careful When Treating Mycotic Nails

The treatment of mycotic nails (without a systemic disease) for an ambulatory patient is covered only when the physician treating a patient for mycotic condition documents the following in the medical record:

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  • That there is clinical evidence of mycosis of the toenail.
  • That the patient has marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.

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