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Routine Foot Care

Number: 0046



Policy

Notes: Routine foot care is not covered under most of Aetna plans.  Please check benefit plan descriptions for details.  Under plans that exclude routine foot care, foot care is considered non-routine and covered only in the following circumstances when medically necessary:

  • The non-professional performance of the service would be hazardous for the member because of an underlying condition or disease; or
  • Routine foot care is performed as a necessary and integral part of an otherwise covered service (e.g., debriding of a nail to expose a subungual ulcer, or treatment of warts); or
  • Debridement of mycotic nails is undertaken when the mycosis/dystrophy of the toenail is causing secondary infection and/or pain, which results or would result in marked limitation of ambulation and require the professional skills of a provider. 

Routine foot care includes, but is not limited to, the treatment of bunions (except capsular or bone surgery thereof), calluses, clavus, corns, hyperkeratosis and keratotic lesions, keratoderma, nails (except surgery for ingrown nails), plantar keratosis, tyloma or tylomata, and tylosis.  The reduction of nails, including the trimming of nails, is also considered routine foot care.

Treatment of these conditions may pose a hazard when performed by a non-professional person on individuals with a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the legs or feet.  Some of the underlying conditions that may justify coverage of foot care that would otherwise be considered routine include arteriosclerosis, chronic thrombophlebitis, diabetes, and peripheral neuropathies.

For plans that do not exclude routine foot care, Aetna does not consider pedicure services, such as routine cutting of nails, in the absence of disease of nails, as treatment of disease.  Please check benefit plan descriptions for details.

Background

The Medicare program also generally does not cover routine foot care.  Medicare assumes that patients or their caregivers will perform these services by themselves.  Medicare has interpreted routine foot care to include, among other things, any foot care services performed in the absence of localized illness, injury or symptoms involving the foot.  Aetna's HMO policy is similar to Medicare policy on routine foot care, in that Medicare also does not cover: cutting or removal of corns and calluses; clipping or trimming of normal or mycotic nails; shaving, paring, cutting or removal of keratoma, tyloma, and heloma; non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage; and other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients.  Exceptions to this exclusion apply for persons with a systemic condition such as metabolic, neurologic, or peripheral vascular disease resulting in circulatory deficits or areas of decreased sensation in the individual’s legs or feet, such that the performance of routine foot care by a non-professional person may pose a hazard.

CPT Codes / HCPCS Codes / ICD-9 Codes
Routine foot care other than debridement of mycotic nails:
CPT codes covered if selection criteria are met:
11055 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion
11056     two to four lesions
11057     more than four lesions
11730 Avulsion of nail plate, partial or complete, simple; single
+ 11732     each additional nail plate ( List separately in addition to code for primary procedure)
11750 Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal
11765 Wedge excision of skin of nail fold (e.g., for ingrown toenail)
Other CPT codes related to the CPB:
17110 - 17111 Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions [treatment of warts]
HCPCS codes covered if selection criteria are met:
G0245 Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS) which must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (4) patient education
G0246 Follow up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS) to include at least the following: (1) a patient history, (2), a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
G0247 Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
S0390 Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific conditions (e.g., diabetes), per visit
ICD-9 codes covered if selection criteria are met:
078.10, 078.19 Viral warts, unspecified and other specified viral warts
111.8 - 111.9 Other and unspecified dermatomycoses
250.00 - 250.93 Diabetes mellitus
337.0 - 337.1 Peripheral autonomic neuropathy
355.0 - 355.8 Mononeuritis of lower limb
356.0 - 356.9 Hereditary and idiopathic peripheral neuropathy
357.0 - 357.9 Inflammatory and toxic neuropathy
440.20 - 440.32 Atherosclerosis of native arteries and bypass graft of extremities
443.0 - 443.1 Raynaud's syndrome and thromboangiitis obliterans [Buerger's disease]
443.81 - 443.9 Other specified and unspecified peripheral vascular diseases
447.1 Stricture of artery
451.0 - 451.2 Phlebitis and thrombophlebitis of lower extremities
457.1 Other lymphedema
459.1 - 459.2 Postphlebitic syndrome and compression of vein
459.81 - 459.89 Other specified disorders of circulatory system
648.00 - 648.04 Diabetes mellitus complicating pregnancy, childbirth, or the puerperium
681.10 - 681.9, 682.6 - 682.7 Cellulitis and abscess of toe, foot, and leg
700 Corns and callosities
701.1 Keratoderma, acquired
703.0 Ingrowing nail
707.15 Ulcer of other part of foot
727.1 Bunion
757.0 Hereditary edema of legs
782.0 Disturbance of skin sensation
782.3 Edema
904.0 - 904.8 Injury to blood vessels of lower extremity
907.5 Late effect of injury to peripheral nerve of pelvic girdle and lower limb
908.3 Late effect of injury to blood vessels of head, neck, and extremities
956.0 - 956.9 Injury to peripheral nerve(s) of pelvic girdle and lower limb
Debridement of mycotic nails:
CPT codes covered if selection criteria are met:
11719 Trimming of non-dystrophic nails, any number
11720 Debridement of nail(s) by any method(s); one to five
11721     six or more
HCPCS codes covered if selection criteria are met:
G0127 Trimming of dystrophic nails, any number
ICD-9 codes covered if selection criteria are met::
110.1 Dermatophytosis of nail
250.00 - 250.93 Diabetes mellitus
356.0 - 356.9 Hereditary and idiopathic peripheral neuropathy
357.2 Polyneuropathy in diabetes
440.20 - 440.32 Atherosclerosis of native arteries and bypass graft of extremities
451.0 - 451.2 Phlebitis and thrombophlebitis of lower extremities
681.10 - 681.9, 682.6 - 682.7 Cellulitis and abscess of toe, foot, and leg
CPT Codes / HCPCS Codes / ICD-10 Codes
Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":
ICD-10 codes will become effective as of October 1, 2015 :
Routine foot care other than debridement of mycotic nails:
CPT codes covered if selection criteria are met:
11055 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion
11056     two to four lesions
11057     more than four lesions
11730 Avulsion of nail plate, partial or complete, simple; single
+ 11732     each additional nail plate ( List separately in addition to code for primary procedure)
11750 Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal
11765 Wedge excision of skin of nail fold (e.g., for ingrown toenail)
Other CPT codes related to the CPB:
17110 - 17111 Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions [treatment of warts]
HCPCS codes covered if selection criteria are met:
G0245 Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS) which must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (4) patient education
G0246 Follow up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS) to include at least the following: (1) a patient history, (2), a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
G0247 Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
S0390 Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific conditions (e.g., diabetes), per visit
ICD-10 codes covered if selection criteria are met:
B07.0 - B07.9 Viral warts
B36.8 - B36.9 Other specified and unspecified superficial mycoses
E08.00 - E13.9 Diabetes mellitus
G57.00 - G57.92 Mononeuropathies of lower limb
G60.0 - G60.9 Hereditary and idiopathic neuropathy
G61.0 - G62.9 Inflammatory, other and unspecified polyneuropathy
G90.01 - G90.09 Idiopathic peripheral autonomic neuropathy
G99.0 Autonomic neuropathy in diseases classified elsewhere
I70.0 - I70.92 Atherosclerosis of native arteries and bypass graft of extremities
I73.00 - I73.01 Raynaud's syndrome
I73.1 Thromboangiitis obliterans [Buerger's disease]
I73.81 Erythromelalgia
I73.89 - I73.9 Other specified and unspecified peripheral vascular diseases
I77.1 Stricture of artery
I79.1 Aortitis in diseases classified elsewhere
I79.8 Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
I80.00 - I80.9 Phlebitis and thrombophlebitis of lower extremities
I87.011 - I87.099 Posthrombotic syndrome
I87.1 Compression of vein
I87.2 Venous insufficiency (chronic) (peripheral)
I87.8 - I87.9 Other specified and unspecified disorders of veins
I89.0 Lymphedema, not elsewhere classified
I99.8 Other disorder of circulatory system
L02.415 - L02.419
L03.115 - L03.129
Abscess, cellulitis and lymphangitis of leg
L02.611 - L02.619
L03.031 - L03.049
Abscess, cellulitis and lymphangitis of toe and foot
L60.0 Ingrowing nail
L84 Corns and callosities
L85.1 Acquired keratosis [keratoderma] palmaris et plantaris
L97.501 - L97.529 Non-pressure chronic ulcer of foot
M20.10 - M20.12 Hallux valgus (acquired)
O24.011 - O24.93 Diabetes mellitus in pregnancy, childbirth, and the puerperium
Q82.0 Hereditary lymphedema
R20.0 - R20.9 Disturbances of skin sensation
R60.0 - R60.9 Edema
S74.00x+ - S74.92x+ Injury to nerves at hip and thigh level
S75.001+ - S75.999+ Injury to blood vessels at hip and thigh level
S85.001+ - S85.999+ Injury of blood vessels at lower leg level
S95.001+ - S95.999+ Injury of blood vessels at ankle and foot level
Numerous options Injury to peripheral nerve of pelvic girdle and lower limb, sequela [Codes not listed due to expanded specificity]
Numerous options Injury to blood vessels of head, neck, and extremities, sequela [Codes not listed due to expanded specificity]
Debridement of mycotic nails:
CPT codes covered if selection criteria are met:
11719 Trimming of non-dystrophic nails, any number
11720 Debridement of nail(s) by any method(s); one to five
11721     six or more
HCPCS codes covered if selection criteria are met:
G0127 Trimming of dystrophic nails, any number
ICD-10 codes covered if selection criteria are met:
B35.1 Tinea unguium
E08.00 - E13.9 Diabetes mellitus
G60.0 - G60.9 Hereditary and idiopathic peripheral neuropathy
I70.0 - I70.92 Atherosclerosis of native arteries and bypass graft of extremities
I80.00 - I80.9 Phlebitis and thrombophlebitis of lower extremities
L02.415 - L02.419
L03.115 - L03.129
Abscess, cellulitis and lymphangitis of leg
L02.611 - L02.619
L03.031 - L03.049
Abscess, cellulitis and lymphangitis of toe and foot


The above policy is based on the following references:
    1. U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Foot care and supportive devices for the feet. Medicare Carriers Manual §2323. Baltimore, MD: HCFA; 2000.
    2. U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Foot care. Medicare Carriers Manual §4120. Baltimore, MD: HCFA; 2000.
    3. Louisiana Medicare Part B. Foot care. Medicare Part B Medical Policy. Baton Rouge, LA: Louisiana Medicare; February 2000. Available at: http://www.lamedicare.com/provider/medpol/footcare.asp. Accessed June 15, 2000.
    4. Yale JF. Yale's Podiatric Medicine. 3rd ed. Baltimore, MD: Williams & Wilkins; 1987.
    5. Neale D, Adams I, eds. Common Foot Disorders. 2nd ed. New York, NY: Churchill Livingstone; 1985.
    6. Melkus GD, Maillet N, Novak J, et al. Primary care cancer and diabetes complications screening of black women with type 2 diabetes. J Am Acad Nurse Pract. 2002;14(1):43-48.
    7. Bending A. Fungal nail infections: Far more than an aesthetic problem. Br J Community Nurs. 2002;7(5):254-259.
    8. Reiber GE, Smith DG, Wallace C, et al. Effect of therapeutic footwear on foot reulceration in patients with diabetes: A randomized controlled trial. JAMA. 2002;287(19):2552-2558.
    9. American Academy of Dermatology, Guidelines/Outcomes Committee. Guidelines of care for superficial mycotic infections of the skin: Onychomycosis. J Am Acad Dermatol. 1996;34(1):116-121.


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