Billing and Coding: Routine Foot Care

Below is a summary of the expected coding and billing to be used when billing for routine foot care that meets the criteria established in the CMS Internet Only Manual, Benefit Policy Manual , Pub 100-02 Chapter 15, Section 290 linked in the Associated Documents section below. Please note the clinical documentation must clearly show that the patient’s condition warrants a provider to render these services in accordance with the above instruction and that failure to provide such professional services would be hazardous to the beneficiary due to their underlying medical condition(s). Failure to properly document the reasoning for the care rendered may result in denial of the claim. In addition, the beneficiary may have complicating diagnosis(es) that require them to be under the care of a primary physician for the disease that is causing the beneficiary to seek provider based routine foot care. For the asterisked conditions, the name of the primary physician (must be a D.O. or M.D.) who made the diagnosis, and the approximate date of the last visit should be included in the record and entered on the appropriate claim forms or electronic equivalent when billing Medicare per the Benefit Policy Manual noted above. Please refer to the CMS website for instructions for billing Part A and Part B claims. There is also information on Noridian’s website for JE Part B claims. Routine foot care services are not restricted to podiatrists. These services may be used by any certified physician or non-physician (NPP) specialty, in keeping with State licensure, if applicable, to provide proper care in either a Part A facility or physician’s office.