Routine Foot Care - Medical Clinical Policy Bulletins (2024)

Information in the [brackets] below has been added for clarification purposes.&nbspCodes requiring a 7th character are represented by"+":

Routine foot care other than debridement of mycotic nails:

CPT codes covered if selection criteria are met:

11055Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion 11056two to four lesions 11057more than four lesions 11730Avulsion of nail plate, partial or complete, simple; single + 11732each additional nail plate ( List separately in addition to code for primary procedure) 11750Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal 11765Wedge excision of skin of nail fold (e.g., for ingrown toenail)

Other CPT codes related to the CPB:

17110 - 17111Destruction, (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:

G0245Initial 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 G0246Follow 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 G0247Routine 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 S0390Routine 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 - E13.9Diabetes mellitus G57.00 - G57.93Mononeuropathies of lower limb G60.0 - G60.9Hereditary and idiopathic neuropathy G61.0 - G62.9Inflammatory, other and unspecified polyneuropathy G90.01 - G90.09Idiopathic peripheral autonomic neuropathy G99.0Autonomic neuropathy in diseases classified elsewhere I70.201 - I70.92Atherosclerosis of native arteries and bypass graft of extremities I73.00 - I73.9Other peripheral vascular diseases I77.1 Stricture of artery I79.1Aortitis in diseases classified elsewhere I79.8Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere I80.00 - I80.9Phlebitis and thrombophlebitis of lower extremities I87.001 - I87.099Posthrombotic syndrome I87.1 Compression of vein I87.2Venous insufficiency (chronic) (peripheral) I87.8 - I87.9Other specified and unspecified disorders of veins I89.0Lymphedema, not elsewhere classified I99.8Other disorder of circulatory system L60.0 Ingrowing nail L97.501 - L97.529Non-pressure chronic ulcer of foot O24.011 - O24.93Diabetes mellitus in pregnancy, childbirth, and the puerperium Q82.0Hereditary lymphedema R60.0 - R60.9Edema 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 - S94.92xSInjury 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):

L84Corns and callosities [clavus, tyloma, tylomata, and tylosis] L85.1Acquired keratosis [keratoderma] palmaris et plantaris [hyperkeratotic lesions, acquired keratoderma, and plantar keratosis] M20.10 - M20.12Hallux valgus (acquired), unspecified foot [covered for capsular or bone surgery only] M21.611 - M21.629Bunion

Debridement of mycotic nails:

CPT codes covered if selection criteria are met:

11719Trimming of non-dystrophic nails, any number 11720Debridement of nail(s) by any method(s); one to five 11721six or more

HCPCS codes covered if selection criteria are met:

G0127Trimming of dystrophic nails, any number

ICD-10 codes covered if selection criteria are met:

B35.1Tinea unguium E08.00 - E13.9Diabetes mellitus G60.0 - G60.9Hereditary and idiopathic peripheral neuropathy I70.201 - I70.92Atherosclerosis of native arteries and bypass graft of extremities I80.00 - I80.9Phlebitis and thrombophlebitis of lower extremities L02.415 - L02.419, L03.115 - L03.119, L03.125 - L03.129Abscess, cellulitis and lymphangitis of lower limb L02.611 - L02.619, L03.031 - L03.049Abscess, cellulitis and lymphangitis of toe and foot