Billing and Coding: Routine Foot Care

Medicare covers routine foot care when either mycotic nails are treated (CPT 11720/11721) with ICD-10-CM B35.1 as the primary diagnosis and an approved secondary diagnosis, or when the patient has one of the listed systemic conditions and required documentation is present. Claims based on systemic conditions must include active MD/DO care documentation, the attending physician name/NPI and DPLS in the CMS-1500 fields, and a billing indicator modifier Q7/Q8/Q9; services and debridement codes that do not meet these criteria are non-covered.

"Nail debridement (CPT 11720 or 11721) for mycotic nails is covered when billed with ICD-10-CM B35."

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