Skip to main content

Coverage criteria policies

Foot care

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

  • Prior authorization is not required for foot care. However, services with specific coverage criteria may be reviewed concurrently or retrospectively to determine whether criteria are being met. Retrospective denial may result if criteria are not met.


  • Foot care is generally not covered per your plan documents. However, certain foot care procedures may pose a hazard when performed by a non-professional person on members with a systemic condition such as metabolic, neurologic, or peripheral vascular disease that has resulted in severe circulatory compromise or areas of desensitization in the legs or feet.

Indications that are covered

Foot care is considered medically necessary for members who have been diagnosed with the medical conditions listed below in the codes section.

Indications that are not covered

  1. Hygiene and preventive maintenance care such as cleaning and soaking the feet or the use of creams to maintain skin tone of both ambulatory and non-ambulatory members.
  2. Foot care performed in the absence of one of the systemic conditions listed below, illness, injury or symptoms involving the foot.


Foot care includes the paring, trimming or removal of corns or calluses, and the trimming, cutting, clipping or debriding of nails (including nails with fungal infection/mycosis).

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

The services associated with these codes DO NOT require prior authorization:




Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion


Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); two to four lesions


Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); more than four lesions


Trimming of non-dystrophic nails, any number


Debridement of nail(s) by any method; 1-5


Debridement of nail(s) by any method; 6 or more


Avulsion of nail plate, partial or complete, simple; single


Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)


Excision of nail and nail matrix, partial or complete (e.g., ingrown or deformed nail) for permanent removal


Wedge excision of skin nail fold (e.g. for ingrown toenail)


Trimming of dystrophic nails, any number


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


Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit

Members with the following medical diagnosis codes are eligible for coverage of routine foot care services:






Other secondary syphilitic conditions


Late syphilitic neuropathy


Fabry’s syndrome


Diabetes mellitus


Amyloid neuropathy


Multiple sclerosis


Hereditary and idiopathic peripheral neuropathy


Inflammatory polyneuropathy


Drug induced polyneuropathy


Alcoholic polyneuropathy


Radiation induced polyneuropathy


Sequelae of toxic polyneuropathy


Unspecified atherosclerosis of native arteries of extremities


Other and unspecified atherosclerosis


Buerger’s disease

I80.0- I80.3

Chronic phlebitis and thrombophlebitis


Intestinal malabsorption (only when coded with G63- polyneuropathy in diseases classified elsewhere

N18.1- N19

Chronic kidney disease


Specific venous and/or nerve injuries of lower limb or foot

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.


This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.


  1. American Diabetes Association. Preventive Foot Care in People With Diabetes. Diabetes Care 2003 Jan; 26(Suppl 1): S78-S79.
  2. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care 2013 Jan; 36 (Suppl 1): S11-S566.
  3. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare Podiatry Services Fact Sheet. April, 2016. Retrieved from
  4. McCullough, D. Patient Education: Foot Care in diabetes mellitus (Beyond the Basics). In: UpToDate, Nathan, D. and Mulder, J. (Ed), UpToDate, Waltham, MA. (Accessed on January 24, 2018).
  5. National Government Services- Manuals- Introduction to Podiatry Services- Foot Care. Retrieved from https://www,

Go to

Policy activity

  • 01/01/1994 - Date of origin
  • 05/01/2017 - Effective date
Review date
  • 03/2018
Revision date
  • 06/20/2016

Related content