G0245, Initial physician evaluation and management of a diabetic patient with diabetic
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.86
Facility
$34.74
Non-Facility
$65.47
Documentation Required
- For diabetic patients with LOPS, documentation elements for G0245 (Initial physician evaluation) must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least: (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.
- For follow-up visits (G0246), documentation must include: (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.
- For routine foot care by a physician of a diabetic patient with LOPS (G0247), documentation must include local care of superficial wounds (if present) and, if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails.
Key Coverage Criteria
- Other disorder of circulatory system (ICD-10: I99.8).
- Ingrowing nail (ICD-10: L60.0).
- Non-pressure chronic ulcer of foot (ICD-10: L97.501 - L97.529).
- Injury of blood vessels at lower leg level (ICD-10: S85.001+ - S85.999+).
- Injury of blood vessels at ankle and foot level (ICD-10: S95.001+ - S95.999+).
- Diabetes mellitus in pregnancy, childbirth, and the puerperium (ICD-10: O24.011 - O24.93).
1 Active Policy
AETNA-CPB-0046, Routine Foot Care
Related Codes
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