Wiki CPT 11055

[Leesburg2]

We are having issues with Medicare not paying for CPT 11055 stating it is non-covered. The provider is using diagnosis code L97.512 as the primary which is (non-pressure chronic ulcer of other part of right foot). Is there anyway to get these paid? The provider does this procedure all the time.

 

[SharonCollachi]

That's not a covered diagnosis for Medicare. Your carrier should have a podiatry coding/billing guide.

 

[thomas7331]

We are having issues with Medicare not paying for CPT 11055 stating it is non-covered. The provider is using diagnosis code L97.512 as the primary which is (non-pressure chronic ulcer of other part of right foot). Is there anyway to get these paid? The provider does this procedure all the time.

Either the CPT or the diagnosis is incorrect. 11055 is the procedure code for the removal of a hyperkeratotic lesion - such as a corn or callus - not for the treatment of a foot ulcer. Foot ulcers are commonly treated by debridement which may often be coded in the CPT range 11042-11045. There must be a mismatch or typo here - you'd need to review the documentation or discuss this with the provider.

 

[erjones147]

Also, Medicare requires Q7/Q8/Q9 modifiers for lesion removals and toe nail cutting (but not for ulcer debridement)