Routine Foot Care

Number: 0046

Table Of Contents

Policy
Applicable CPT / HCPCS / ICD-10 Codes
Background
References

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Policy

Scope of Policy

This Clinical Policy Bulletin addresses routine foot care.

1. Medical Necessity

   Notes: Routine foot care is not covered under most of Aetna plans. Please check benefit plan descriptions for details. Under plans that exclude routine foot care, foot care is considered non-routine and covered only in the following circumstances when medically necessary:

   1. The non-professional performance of the service would be hazardous for the member because of an underlying condition or disease; or
   2. Routine foot care is performed as a necessary and integral part of an otherwise covered service (e.g., debriding of a nail to expose a subungual ulcer, or treatment of warts); or
   3. Debridement of mycotic nails is undertaken when the mycosis/dystrophy of the toenail is causing secondary infection and/or pain, which results or would result in marked limitation of ambulation and require the professional skills of a provider.

Routine foot care includes, but is not limited to, the treatment of bunions (except capsular or bone surgery thereof), calluses, clavus, corns, hyperkeratosis and keratotic lesions, keratoderma, nails (except surgery for ingrown nails), plantar keratosis, tyloma or tylomata, and tylosis.  The reduction of nails, including the trimming of nails, is also considered routine foot care.

Treatment of these conditions may pose a hazard when performed by a non-professional person on individuals with a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the legs or feet.  Some of the underlying conditions that may justify coverage of foot care that would otherwise be considered routine include arteriosclerosis, chronic thrombophlebitis, diabetes, and peripheral neuropathies.

For plans that do not exclude routine foot care, Aetna does not consider pedicure services, such as routine cutting of nails, in the absence of disease of nails, as treatment of disease.  Please check benefit plan descriptions for details.

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Table:

CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":
Routine foot care other than debridement of mycotic nails:
CPT codes covered if selection criteria are met:
11055	Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion
11056	two to four lesions
11057	more than four lesions
11730	Avulsion of nail plate, partial or complete, simple; single
+ 11732	each additional nail plate ( List separately in addition to code for primary procedure)
11750	Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal
11765	Wedge excision of skin of nail fold (e.g., for ingrown toenail)
Other CPT codes related to the CPB:
17110 - 17111	Destruction, (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions [treatment of warts]
HCPCS codes covered if selection criteria are met:
G0245	Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS) which must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that consists of at least the following elements: (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
G0246	Follow up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in loss of protective sensation (LOPS) to include at least the following: (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
G0247	Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
S0390	Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific conditions (e.g., diabetes), per visit
ICD-10 codes covered if selection criteria are met (non-routine):
E08.00 - E13.9	Diabetes mellitus
G57.00 - G57.93	Mononeuropathies of lower limb
G60.0 - G60.9	Hereditary and idiopathic neuropathy
G61.0 - G62.9	Inflammatory, other and unspecified polyneuropathy
G90.01 - G90.09	Idiopathic peripheral autonomic neuropathy
G99.0	Autonomic neuropathy in diseases classified elsewhere
I70.201 - I70.92	Atherosclerosis of native arteries and bypass graft of extremities
I73.00 - I73.9	Other peripheral vascular diseases
I77.1	Stricture of artery
I79.1	Aortitis in diseases classified elsewhere
I79.8	Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere
I80.00 - I80.9	Phlebitis and thrombophlebitis of lower extremities
I87.001 - I87.099	Posthrombotic syndrome
I87.1	Compression of vein
I87.2	Venous insufficiency (chronic) (peripheral)
I87.8 - I87.9	Other specified and unspecified disorders of veins
I89.0	Lymphedema, not elsewhere classified
I99.8	Other disorder of circulatory system
L60.0	Ingrowing nail
L97.501 - L97.529	Non-pressure chronic ulcer of foot
O24.011 - O24.93	Diabetes mellitus in pregnancy, childbirth, and the puerperium
Q82.0	Hereditary lymphedema
R60.0 - R60.9	Edema
S85.001+ - S85.999+	Injury of blood vessels at lower leg level
S95.001+ - S95.999+	Injury of blood vessels at ankle and foot level
S74.00xS - S74.92xS, S84.00xS - S84.92xS, S94.00xS - S94.92xS	Injury to peripheral nerve of pelvic girdle and lower limb, sequela
ICD-10 code not covered for indications listed in the CPB (routine) (not all-inclusive):
L84	Corns and callosities [clavus, tyloma, tylomata, and tylosis]
L85.1	Acquired keratosis [keratoderma] palmaris et plantaris [hyperkeratotic lesions, acquired keratoderma, and plantar keratosis]
M20.10 - M20.12	Hallux valgus (acquired), unspecified foot [covered for capsular or bone surgery only]
M21.611 - M21.629	Bunion
Debridement of mycotic nails:
CPT codes covered if selection criteria are met:
11719	Trimming of non-dystrophic nails, any number
11720	Debridement of nail(s) by any method(s); one to five
11721	six or more
HCPCS codes covered if selection criteria are met:
G0127	Trimming of dystrophic nails, any number
ICD-10 codes covered if selection criteria are met:
B35.1	Tinea unguium
E08.00 - E13.9	Diabetes mellitus
G60.0 - G60.9	Hereditary and idiopathic peripheral neuropathy
I70.201 - I70.92	Atherosclerosis of native arteries and bypass graft of extremities
I80.00 - I80.9	Phlebitis and thrombophlebitis of lower extremities
L02.415 - L02.419, L03.115 - L03.119, L03.125 - L03.129	Abscess, cellulitis and lymphangitis of lower limb
L02.611 - L02.619, L03.031 - L03.049	Abscess, cellulitis and lymphangitis of toe and foot

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Background

The Medicare program also generally does not cover routine foot care.  Medicare assumes that patients or their caregivers will perform these services by themselves.  Medicare has interpreted routine foot care to include, among other things, any foot care services performed in the absence of localized illness, injury or symptoms involving the foot.  Aetna's HMO policy is similar to Medicare policy on routine foot care, in that Medicare also does not cover: cutting or removal of corns and calluses; clipping or trimming of normal or mycotic nails; shaving, paring, cutting or removal of keratoma, tyloma, and heloma; non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage; and other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet and the use of skin creams to maintain skin tone of both ambulatory and bedridden patients.  Exceptions to this exclusion apply for persons with a systemic condition such as metabolic, neurologic, or peripheral vascular disease resulting in circulatory deficits or areas of decreased sensation in the individual’s legs or feet, such that the performance of routine foot care by a non-professional person may pose a hazard.

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References