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:

The routine foot care is a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds, infections, and fractures. 

The presence of a systemic condition such as metabolic, neurologic, or peripheral vascular disease that may require scrupulous foot care by a professional.  

When a complicating systemic condition is present, the patient must have Class A, B or C findings. It must be documented in the medical record to append appropriate modifier with podiatry CPT codes.

• Class A Finding (Q7): Nontraumatic amputation of foot or integral skeletal portion thereof.
• Class B Findings (Q8):
  • Absent posterior tibial pulse 
  • Absent dorsalis pedis pulse 
  • Advanced trophic changes (at least three of the following): 
    • Decrease or absence of hair growth 
    • Nail thickening 
    • Skin discoloration 
    • Thin and shiny skin texture 
    • Rubor or redness of skin
• Class C findings (Q9) (one Class B and two Class C findings required): 
  •  Claudication (e.g., leg or calf pain with walking; pain in calf causing limping; cessation of walking secondary to calf pain) 
  • Temperature changes (cold feet)
  • Paresthesias (abnormal spontaneous sensations in the feet)
  • Burning
  • Edema.