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.
| Code | Code Description |
|---|---|
Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+": |
|
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 (non-routine): |
|
| E08.00 - E13.9 | Diabetes mellitus |
| G57.00 - G57.93 | 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 |
| I70.201 - I70.92 | Atherosclerosis of native arteries and bypass graft of extremities |
| I73.00 - I73.9 | Other 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 |
| I87.001 - 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 |
| L60.0 | Ingrowing nail |
| L97.501 - L97.529 | Non-pressure chronic ulcer of foot |
| O24.011 - O24.93 | Diabetes mellitus in pregnancy, childbirth, and the puerperium |
| Q82.0 | Hereditary lymphedema |
| R60.0 - R60.9 | Edema |
| 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 |
| S74.00xS - S74.92xS, S84.00xS - S84.92xS, S94.00xS - S94.92xS | Injury to peripheral nerve of pelvic girdle and lower limb, sequela |
ICD-10 code not covered for indications listed in the CPB (routine) (not all-inclusive): |
|
| L84 | Corns and callosities [clavus, tyloma, tylomata, and tylosis] |
| L85.1 | Acquired keratosis [keratoderma] palmaris et plantaris [hyperkeratotic lesions, acquired keratoderma, and plantar keratosis] |
| M20.10 - M20.12 | Hallux valgus (acquired), unspecified foot [covered for capsular or bone surgery only] |
| M21.611 - M21.629 | Bunion |
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 |
| I70.201 - 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 - L03.119, L03.125 - L03.129 | Abscess, cellulitis and lymphangitis of lower limb |
| 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:
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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.
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U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Foot care. Medicare Carriers Manual §4120. Baltimore, MD: HCFA; 2000.
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Louisiana Medicare Part B. Foot care. Medicare Part B Medical Policy. Baton Rouge, LA: Louisiana Medicare; February 2000.
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Yale JF. Yale's Podiatric Medicine. 3rd ed. Baltimore, MD: Williams & Wilkins; 1987.
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Neale D, Adams I, eds. Common Foot Disorders. 2nd ed. New York, NY: Churchill Livingstone; 1985.
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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.
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Bending A. Fungal nail infections: Far more than an aesthetic problem. Br J Community Nurs. 2002;7(5):254-259.
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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.
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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.
