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HealthPartners

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.

Coverage

  • 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.

Definitions

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:

Codes

Description

11055

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

11056

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

11057

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

11719

Trimming of non-dystrophic nails, any number

11720

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

11721

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

11730

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

11732

Avulsion of nail plate, partial or complete, simple; 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 nail fold (e.g. for ingrown toenail)

G0127

Trimming of dystrophic nails, any number

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 medical conditions (e.g., diabetes), per visit

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

Codes

Description

A30.0-A30.9

Leprosy

A51.49

Other secondary syphilitic conditions

A52.15

Late syphilitic neuropathy

E75.21

Fabry’s syndrome

E08.00-E13.9

Diabetes mellitus

E85.0-E85.9

Amyloid neuropathy

G35

Multiple sclerosis

G60.0-G60.9

Hereditary and idiopathic peripheral neuropathy

G61.0-61.9

Inflammatory polyneuropathy

G62.0

Drug induced polyneuropathy

G62.1

Alcoholic polyneuropathy

G62.82

Radiation induced polyneuropathy

G65.2

Sequelae of toxic polyneuropathy

I70.20-I70.29

Unspecified atherosclerosis of native arteries of extremities

I70.8-I70.91

Other and unspecified atherosclerosis

I73.1

Buerger’s disease

I80.0- I80.3

Chronic phlebitis and thrombophlebitis

K90.9

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

N18.1- N19.0

Chronic kidney disease

S75.0-S95.99

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.

Products

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.

References

  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 https://www.cms.gov/Outreach-and-Education/Outreach-and-Education.html
  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,ngsmedicare.com.

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Policy activity

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

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