Coverage of Foot Care Services

Noridian has noted, through Medical Review, billing of foot care services as non-covered when documentation supports the patient has complaints of associated foot pain. The purpose of this educational article is to clarify coverage of foot care services related to pain. The Medicare Benefit Policy Manual (MBPM) Chapter 15 section 290.C.1 (http://www.cms.hhs.gov) states, "In certain circumstances, services ordinarily considered to be routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds, or infections." In this regard, foot care services associated with a patient's complaints of pain would not be considered routine in nature. Pain may indicate a problem, such as an ulcer or infection, which is necessary to evaluate. If pain is associated with the reason for the foot care, it is reasonable and necessary for the medical professional to assess and evaluate the pain, and subsequently treat both the pain and the cause of the pain if possible. For all other covered indications for foot care services, including presumption of coverage guidelines, as well as foot care excluded from Medicare coverage, refer to the MBPM Chapter 15 section 290. Source: Medicare Benefit Policy Manual (MBPM) Chapter 15 section 290 Social Security Act (SSA) Title XVIII section 1862(a)(1)(A)