Debridement of Mycotic Nails

Medicare covers debridement of mycotic (fungal) toenails when clinical evidence of onychomycosis exists and either the national 'Exceptions to Routine Foot Care' criteria are met or the patient has marked ambulation limitation, secondary soft-tissue infection, or other documented complicating conditions. Coverage is generally as an adjunct to FDA‑indicated antifungal pharmacologic therapy; laboratory confirmation is not routinely required but is expected in recurrent cases, when planning prolonged antifungal treatment, when debridement exceeds frequency thresholds (e.g., >12 in 24 months), or when debridement is provided without concomitant pharmacologic therapy.

"Medicare payment may be made for debridement when there is clinical evidence of onychomycosis (mycotic toenail infection) and the services and patient conditions meet the national 'Exceptions to Ro..."