About this policy
Jurisdiction: J9 MAC Part B. States: Florida, Puerto Rico, US Virgin Islands. Type: Active LCD
Coverage indications
Please refer to CMS IOM Publication 100-02, Medicare Benefit Policy Manual , Chapter 15, Section 290 Foot Care for indications and limitations in coverage of routine foot care. Covered Indications Routine foot care may be available for patients with peripheral neuropathy involving the feet, but without vascular impairment. The neuropathy should be of such severity that care by a non- professional person would put the patient at risk. The medical record must document the patient has an absence of sensation at two or more sites out of five tested on either foot when tested with the 5.07 Semmes-Weinstein monofilament to support the diagnosis of peripheral neuropathy with loss of protective sensation. This testing may be performed by the attending physician, non-physician practitioner, or the podiatrist. For patients requiring anticoagulation therapy, the provider must document in the medical record the significant risk and danger posed by the non-professional rendering routine foot care services. Limitations As published in the CMS IOM Publication 100-08, Medicare Program Integrity Manual , Chapter 13, Section 13.5.4, an item or service may be covered by a contractor LCD if it is reasonable and necessary under the Social Security Act Section 1862 (a)(1)(A). Contractors shall determine and describe the circumstances under which the item or service is considered reasonable and necessary.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 11055 | CPT | Covered |
| 11056 | CPT | Covered |
| 11057 | CPT | Covered |
| 11719 | CPT | Covered |
| 11720 | CPT | Covered |
| 11721 | CPT | Covered |
| G0127 | HCPCS | Covered |
| A30.0 | ICD10CM | Covered |
| A30.1 | ICD10CM | Covered |
| A30.2 | ICD10CM | Covered |
| A30.3 | ICD10CM | Covered |
| A30.4 | ICD10CM | Covered |
| A30.5 |