According to Medicare guidelines, they will cover foot care services only when it is medically necessary and reasonable. Certain foot care related services, unless listed under “conditions that might justify coverage”, are not generally covered by Medicare.
In general, the following services are not covered by Medicare:
- Treatment of flat foot-defined as a condition in which one or more arches of the foot have flattened out. Services or devices directed toward the correction of such conditions are not covered.
- Routine foot care is excluded from coverage. Services that are normally considered routine and are not covered include the following:
- The cutting or removal of corns and calluses
- The trimming, cutting, clipping or debriding of nails
- Other hygienic and preventive maintenance care, such as cleaning and soaking of the feet, the use of foot creams, and any other service performed in the absence of localized illness or injury
- Supportive Devices for Feet; orthopedic shoes and other supportive devices for the feet are generally not covered, except if shoe is an integral part of a leg brace or special circumstances for patients with diabetes
The exclusion of foot care is determined by the nature of the service and not according to who provides the service. When a claim shows both covered and non-covered services the portion of the charges that are attributable to the non-covered services will be denied.
Conditions that Might Justify Coverage
Foot care which would otherwise be considered routine (and therefore not covered), may be covered when a systemic condition(s) results in severe circulatory embarrassment or areas of diminished sensation in the individual’s legs or feet. Such systemic conditions may pose a hazard to the patient when performed by a non-professional person.
For coding questions or coding corner suggestions: UHAcoding.billing.help@stanfordhealthcare.org