Originally published October 12, 2017. Payer rules change; confirm current CMS and payer requirements before billing.
Routine foot care codes: 11055, 11056, 11057, 11719, 11720, 11721 and G0127.
Routine foot care is not a covered Medicare benefit. Medicare assumes the patient or caregiver can do it, so it is excluded from coverage. Medicare makes exceptions when a medical condition puts the patient at higher risk of infection or injury if a non-professional provides the care.
When Medicare may cover routine foot care
- The foot care is a necessary and integral part of an otherwise covered service, such as treating ulcers, wounds, infections or fractures.
- The patient has a systemic condition, such as metabolic, neurologic or peripheral vascular disease, that requires professional foot care.
When a complicating systemic condition is present, the patient must have Class A, B or C findings, documented in the medical record, to append the right modifier to the podiatry CPT code.
Class findings and modifiers
Class A (Q7): nontraumatic amputation of the foot or an integral skeletal part of it.
Class B (Q8), two findings required:
- Absent posterior tibial pulse
- Absent dorsalis pedis pulse
- Advanced trophic changes, at least three of: decreased or absent hair growth, nail thickening, skin discoloration, thin and shiny skin, rubor or redness
Class C (Q9), one Class B and two Class C findings required:
- Claudication (for example, calf pain when walking that causes limping or stopping)
- Temperature changes (cold feet)
- Paresthesias (abnormal spontaneous sensations in the feet)
- Burning
- Edema