Routine Foot Care
Number: 0046
Table Of Contents
PolicyApplicable CPT / HCPCS / ICD-10 Codes
Background
References
Policy
Scope of Policy
This Clinical Policy Bulletin addresses routine foot care.
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Medical Necessity
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.
References
The above policy is based on the following references:
- 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.
- Bending A. Fungal nail infections: Far more than an aesthetic problem. Br J Community Nurs. 2002;7(5):254-259.
- Louisiana Medicare Part B. Foot care. Medicare Part B Medical Policy. Baton Rouge, LA: Louisiana Medicare; February 2000.
- 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.
- Neale D, Adams I, eds. Common Foot Disorders. 2nd ed. New York, NY: Churchill Livingstone; 1985.
- O'Connor JJ, Deroche CB, Wipke-Tevis DD, et al. Foot care self-management in non-diabetic older adults: A pilot controlled trial. West J Nurs Res. 2021;43(8):751-761.
- 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.
- 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.
- U.S. Department of Health and Human Services, Health Care Financing Administration (HCFA). Foot care. Medicare Carriers Manual §4120. Baltimore, MD: HCFA; 2000.
- Yale JF. Yale's Podiatric Medicine. 3rd ed. Baltimore, MD: Williams & Wilkins; 1987.
