Routine Foot Care and Debridement of Nails

Medicare generally excludes routine foot care (cutting corns/calluses, nail trimming, hygienic foot care), but exceptions allow coverage when there is significant systemic disease (metabolic, neurologic, or peripheral vascular) putting patients at risk, when foot care is integral to treatment of ulcers/wounds/infections, for wart treatment, and for specific toenail conditions (onychomycosis, onychogryphosis, onychauxis) meeting stated clinical criteria. Coverage can be presumed if documented Class A/B/C findings meet the policy rule (Class A; or two Class B; or one Class B plus two Class C), and documentation requirements include recording class findings, discussion of antifungal options for mycotic nails, appropriate ICD-10 codes for neuropathy, evidence of active care for complicating diseases within six months, and use of modifier 25 with documented separate E&M services when applicable.

"Routine foot care services may be covered when the patient has a systemic disease (metabolic, neurologic, or peripheral vascular) of sufficient severity that performance of such services by a nonpr..."