Routine foot care billing

Routine foot care : 11055,  11056, 11057,  11719,  11720,  11721, G0127

Routine foot care is not a covered Medicare benefit. Medicare assumes that the beneficiary or caregiver will perform these services by themselves, and therefore, they are excluded from coverage. Medicare allows exceptions to this exclusion when medical conditions exist that place the patient at increased risk of infection and/or injury if a non-professional would provide these services. Medicare may cover routine foot care in the following situations:

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Insurance Plans

HMO plans

With an HMO plan, you pick one primary care physician. All your health care services go through that doctor. That means that you need a referral before you can see any other health care professional, except in an emergency. Visits to health care professionals outside of your network typically aren’t covered by your insurance.

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NCCI Modifiers

National Correct Coding Initiative (NCCI)

The set of edits developed by CMS where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations.

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Timeframe between Annual Wellness Visits (AWVs)

The exact timeframe between AWV is a little confusing.  Annual Wellness Visits (AWVs) are covered by Medicare at 12-month intervals. This means that 11 full calendar months must pass after the month in which a beneficiary had received an AWV.

For example, if AWV was performed on Jan 31, 2016 the patient is eligible to AWV starting from Jan 1, 2017

The exact day of the month doesn’t matter. AWV could have been done on Jan 1 or Jan 31 (or any other day of January) and the patient will be eligible for new AWV starting from January 1 next year.

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