Does G0127 require prior authorization?

No, G0127 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for G0127?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.17.

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`G0127`, Trimming of dystrophic nails, any number

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.17

Facility

N/A

Non-Facility

N/A

Documentation Required

When routine foot care needs to meet one of the exclusions, include the applicable Q modifier on the claim: Q7 for 1 Class A finding, Q8 for 2 Class B findings, and Q9 for 1 Class B plus 2 Class C findings.
For all foot-care claims report an appropriate foot/toe location modifier (e.g., LT, RT, TA, T1-T9) to identify laterality and specific toe when applicable.

If a significant, separately identifiable evaluation and management service is provided on the same day as routine foot care, append modifier -25 to the E/M claim line.

Total the number of keratotic lesions debrided and select the most appropriate CPT code 11055-11057 based on that total (example: code 11056 for two to four lesions).

When reporting an ICD-10-CM code that falls under the active care requirement, report the date the beneficiary was last seen by the MD, DO, or qualified NPP responsible for treating the underlying condition in line 19 of the CMS-1500 or the electronic equivalent.

Services must be reported using the procedure code that most accurately describes the procedure performed.

Key Coverage Criteria

Removal of corns and calluses of the feet must be billed using CPT codes 11055-11057 (paring/cutting of benign hyperkeratotic lesion) and the procedure code that most accurately describes the service performed should be reported.
Foot care services are covered when the beneficiary has a listed systemic condition that justifies coverage per Medicare Benefit Policy Manual Pub.100-02, Ch.15, Section 290.4D.
For diagnosis codes designated by an asterisk, the patient must be under the active care of an M.D. or D.O., documented as having been seen for the complicating disease within the 6 months prior to service.
Claims asserting presumptive coverage must include a systemic-condition diagnosis from IOM 100-02 Ch.15 Section 290 Group 1 and a valid billing modifier Q7, Q8, or Q9.
Mycotic nail debridement is covered when mycotic nails are present in the context of a systemic disease with class findings and the appropriate Q modifier on the claim.
Mycotic nail debridement is covered without systemic disease if an ambulatory patient has marked limitation of ambulation, pain, or secondary infection from thickened/dystrophic infected toenail plate.

18 Active Policies

CGS-J15-L34246, Routine Foot Care and Debridement of Nails

J15

CGS-J18-L34246, Routine Foot Care and Debridement of Nails

J18

A56232, Billing and Coding: Foot Care

A57759, Billing and Coding: Routine Foot Care and Debridement of Nails

NGS-J6-L33636, Routine Foot Care and Debridement of Nails

FIRST_COAST-L33941, Routine Foot Care

NOVITAS-JH-L35138, Routine Foot Care

PALMETTO-JJ-L37643, Routine Foot Care

NGS-JK-L33636, Routine Foot Care and Debridement of Nails

NOVITAS-JL-L35138, Routine Foot Care

A52996, Billing and Coding: Routine Foot Care

PALMETTO-JM-L37643, Routine Foot Care

A57193, Billing and Coding: Routine Foot Care and Debridement of Nails

A56680, Billing and Coding: Routine Foot Care

A57188, Billing and Coding: Routine Foot Care

AETNA-CPB-0046, Routine Foot Care

ANTHEM-CG-MED-92, Foot Care Services

A57954, Billing and Coding: Routine Foot Care

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G0127, Trimming of dystrophic nails, any number