This article is for podiatrists caring for our Medicare Advantage members
Recently, we’ve noticed an increased number of podiatrists submitting claims for non-covered routine foot care for Medicare Advantage members. Since Medicare generally excludes coverage for routine foot care, this results in denied claims with members receiving unexpected charges.
As a reminder, routine foot care includes:
- Cutting or removing corns and calluses
- Trimming, cutting, or clipping nails
- Hygienic or preventive maintenance, like cleaning or soaking feet
Medical Necessary coverage
Payment may be made for routine foot care when the patient has a systemic disease—such as metabolic, neurologic, or peripheral vascular disease—of sufficient severity that performance of such services by a nonprofessional person would put the patient at risk (for example, a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the patient’s legs or feet).
For Medicare Advantage members, providers should follow the appropriate local coverage determination (LCD) prior to rendering services to determine if the services meet medically necessity guidelines.
Related medical policy
Medical
policy 132, Medicare Advantage Management
Questions?
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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