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Medicare Advantage Plans and routine foot care

M

mcarter1017

Contributor
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Does anyone know if Medicare Advantage Plans, such as Humana, Anthem, Aetna, are covering routine foot care (11720,11721)? I have tried to research, but everything I find states it is plan specific. My employer wants to know in general who will pay and who wont..can anyone help???
 
Routine foot care

The advantage plans are not held to Medicare standards. These plans can do what they want with benefits. This means that you would need to contact your provider reps for each carrier and get the specifics. Keep in mind that Aetna and other Advantage plans can have more than one advantage plan and the benefit may be different for each. Some plans limit routine care to one routine service in a 12 month period regardless of who bills it.
 
Routine Foot Care

As a Medicare Advantage plan they are required to cover any Medicare covered service. http://www.cms.gov/Outreach-and-Edu...rogram/Training-Library-Items/CMS1241850.html
Per CMS - Routine Foot Care is a Medicare Exclusion except in the presence of a systemic condition such as metabolic, neurologic, or peripheral vascular disease. "Accordingly, foot care that would otherwise be considered routine may be covered when systemic condition(s) result in severe circulatory embarrassment or areas of diminished sensation in the individual's legs or feet." https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/SE1113.pdf.
There are very precise coverage criteria and coding guidelines for these services. It is highly recommended that you find your local Medicare carriers LCD (Local Coverage determination) for specifics.
It is not uncommon for Insurance carriers to set their systems to automatically deny these services regardless how they are billed. We frequently have to appeal and request the Payers to correct their programming of these codes to support the Medicare rules.
If you have specifics you can email me and I can attempt to assist you. Dnolan@ankleandfootclinic.com
 
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