Routine Foot Care

LCD Information Document Information Source LCD ID N/A LCD ID L37643 Original ICD-9 LCD ID Not Applicable LCD Title Routine Foot Care Proposed LCD in Comment Period N/A Source Proposed LCD N/A Original Effective Date For services performed on or after 01/29/2018 Revision Effective Date For services performed on or after 12/05/2019 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date 12/14/2017 Notice Period End Date 01/28/2018 CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Title XVIII of the Social Security Act, §1862 (a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, §1862 (a)(13)(C) defines the exclusion for payment of routine foot care. 42 CFR Section 411.15 (l) Particular services excluded from coverage. CMS Internet- Only Manual, Pub 100-02, Medicare Benefit Policy Manual, Chapter 15, §290 Foot Care CMS Internet- Only Manual, Pub 100-03, Medicare National Coverage Determination Manual, Chapter 1, §70.2.1 Services Provided for the Diagnosis and Treatment of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy) Coverage Indications, Limitations, and/or Medical Necessity BackgroundGenerally, routine foot care is excluded from coverage. Services that normally are considered routine and not covered by Medicare include the following, regardless of the provider rendering the service: Cutting or removal of corns and calluses; Trimming, cutting, clipping or debridement of nails, including debridement of mycotic nails; Shaving, paring, cutting or removal of keratoma, tyloma and heloma; Non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage; Other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet, the use of skin creams to maintain skin tone of either ambulatory or bedfast patients; Any other service performed in the absence of localized illness, injury or symptoms involving the foot. There are exceptions to routine foot care exclusions. This local coverage determination (LCD) outlines such exceptions. IndicationsRoutine foot care services are subject to national regulation, which provides definitions, indications and limitations for Medicare payment of routine foot care services.Exceptions to routine foot care exclusions include: Routine foot care that is necessary and an integral part of an otherwise covered service; Treatment of warts on foot; The presence of systemic conditions, such as metabolic, neurologic, or peripheral vascular disease; Mycotic nails: In the presence of systemic conditions as noted above in #3. In the absence of systemic conditions: An ambulatory patient must have marked limitation of ambulation, pain or secondary infection resulting from the thickening and dystrophy of infected toenail plate. A non-ambulatory patient suffers from pain or secondary infection resulting from the thickening and dystrophy of an infected toenail plate. Presumption of CoverageIn evaluating whether the routine services can be reimbursed, a presumption of coverage may be made where the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement. For purposes of applying this presumption the following findings are pertinent: Class A Findings Nontraumatic amputation of foot or integral skeletal portion thereof. Class B Findings Absent posterior tibial pulse; Advanced trophic changes as: hair growth (decrease or absence), nail changes (thickening), pigmentary changes (discoloration), skin texture (thin, shiny), skin color (rubor or redness) (three required) and; Absent dorsalis pedis pulse. Class C Findings Claudication; Temperature changes (e.g., cold feet); Edema; Paresthesias (abnormal spontaneous sensations in the feet) and; Burning. The presumption of coverage may be applied when the physician rendering the routine foot care has identified: One Class A finding; Two of the Class B findings; or One Class B and two Class C findings. Limitations 1.Covered exceptions to routine foot care services are considered medically necessary once (1) in 60 days. 2.The exclusion of foot care is determined by the nature of the service, regardless of the clinician who performs the service. Loss of protective sensation (LOPS) is not the subject of this LCD. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

Background Generally, routine foot care is excluded from coverage. Services that normally are considered routine and not covered by Medicare include the following, regardless of the provider rendering the service: Cutting or removal of corns and calluses; Trimming, cutting, clipping or debridement of nails, including debridement of mycotic nails; Shaving, paring, cutting or removal of keratoma, tyloma and heloma; Non-definitive simple, palliative treatments like shaving or paring of plantar warts which do not require thermal or chemical cautery and curettage; Other hygienic and preventive maintenance care in the realm of self care, such as cleaning and soaking the feet, the use of skin creams to maintain skin tone of either ambulatory or bedfast patients; Any other service performed in the absence of localized illness, injury or symptoms involving the foot. There are exceptions to routine foot care exclusions. This local coverage determination (LCD) outlines such exceptions. Indications Routine foot care services are subject to national regulation, which provides definitions, indications and limitations for Medicare payment of routine foot care services. Exceptions to routine foot care exclusions include: Routine foot care that is necessary and an integral part of an otherwise covered service; Treatment of warts on foot; The presence of systemic conditions, such as metabolic, neurologic, or peripheral vascular disease; Mycotic nails: In the presence of systemic conditions as noted above in #3. In the absence of systemic conditions: An ambulatory patient must have marked limitation of ambulation, pain or secondary infection resulting from the thickening and dystrophy of infected toenail plate. A non-ambulatory patient suffers from pain or secondary infection resulting from the thickening and dystrophy of an infected toenail plate. Presumption of Coverage In evaluating whether the routine services can be reimbursed, a presumption of coverage may be made where the evidence available discloses certain physical and/or clinical findings consistent with the diagnosis and indicative of severe peripheral involvement. For purposes of applying this presumption the following findings are pertinent: Class A Findings Nontraumatic amputation of foot or integral skeletal portion thereof. Class B Findings Absent posterior tibial pulse; Advanced trophic changes as: hair growth (decrease or absence), nail changes (thickening), pigmentary changes (discoloration), skin texture (thin, shiny), skin color (rubor or redness) (three required) and; Absent dorsalis pedis pulse. Class C Findings Claudication; Temperature changes (e.g., cold feet); Edema; Paresthesias (abnormal spontaneous sensations in the feet) and; Burning. The presumption of coverage may be applied when the physician rendering the routine foot care has identified: One Class A finding; Two of the Class B findings; or One Class B and two Class C findings. Limitations 1.Covered exceptions to routine foot care services are considered medically necessary once (1) in 60 days. 2.The exclusion of foot care is determined by the nature of the service, regardless of the clinician who performs the service. Loss of protective sensation (LOPS) is not the subject of this LCD.