Podiatry Coding & Billing Alert

Question: How often can we bill Medicare for an evaluation of the feet? Is the exam only covered for certain diagnoses?

Wisconsin Subscriber

Answer: Medicare covers an evaluation (examination and treatment) of the feet no more than every six months for individuals with a documented diagnosis of diabetic sensory neuropathy (250.60, 337.1) with loss of protective sensation (LOPS), as long as the beneficiary has not seen a foot care specialist for some other reason in the interim.This is known as the bi-annual exam.

For a new patient, you would report G0245 (Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation [LOPS] which must include [1]  the diagnosis of LOPS, [2] a patient history, [3] a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and [4] patient education).

For a follow up exam, select G0246 (Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy ...).

Key: The diagnosis of diabetic sensory neuropathy with LOPS should be established and documented prior to foot care coverage. The primary care physician should consider and investigate other causes of peripheral neuropathy prior to initiating or referring for foot care for persons with LOPS.

Please refer to the National Coverage Determination Manual (Pub 100-3) Section 70.2.1 for additional information at www.cms.hhs.gov/manuals/downloads/ncd103c1_part1.pdf.