Podiatry Coding & Billing Alert

Question: Is paring callouses (11055-11057) only covered at the same frequency as nails (11720 and 11721) — every 10 weeks?

AAPC Forum Participant

Answer: Per Medicare Local Coverage Determination (LCD) 35138, “the frequency of routine foot care varies among patients. Medicare will cover routine foot care as often as is medically necessary but no more often than every 60 days” (www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35138). Both the cutting or removal of corns and calluses, as described by CPT^® 11055-11057 (Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus) …), and trimming, cutting, clipping, or debriding of nails, described by 11720-11721 (Debridement of nail(s) by any method(s) …), would qualify as routine foot care services by Medicare’s definition.

Remember: Routine foot care is excluded from Medicare coverage. However, “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 [or] the presence of a systemic condition.” Such conditions “may require scrupulous foot care by a professional that in the absence of such condition(s) would be considered routine (and, therefore, excluded from coverage) per the Medicare Benefit Policy Manual (Chapter 15, Section 290 B2 and C) (www.cms. gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ bp102c15.pdf).

You should consult both the Policy Manual and the LCD for lists of systemic conditions that would exempt 11055-11057 and 11720-11721 from being considered routine foot care services.