When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
American Academy of Orthopaedic Surgeons (AAOS). Care of the Diabetic Foot. [AAOS Web site]. Last reviewed September 2017. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00148. Accessed February 23, 2018.
American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014; vol. 37, Supplement 1 S14-S80.
Centers for Medicare and Medicaid Services (CMS). Medicare Benefit Policy Manual. Chapter 15: Covered Medical and Other Health Services. §290: Foot care. [CMS Web site]. 10/01/03. Available at: https://www.cms.gov/manuals/Downloads/bp102c15.pdf. Accessed February 23, 2018.
Company Benefit Contracts.
Frykberg RG, Zgonis T, Armstrong DG, et al. Diabetic foot disorders: A clinical practice guideline. J Foot Ankle Surg. 2006;45(5 Suppl):S1-S66.
Harless LB, Satterfield VK, Dennis KJ. Role of the podiatrist. In: Bowker JH, Pfeiffer MA, eds. Levin and O'Neal's The Diabetic Foot. 6th ed. St. Louis, MO: Mosby, Inc; 2001: 682-699.
Novitas Solutions, Inc. A52996: Routine foot care (article). [Novitas Solutions Web site]. 10/01/2015. Available at: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52996&ver=5&ContrId=323&ContrVer=1&CntrctrSelected=323*1&Date=10%2f06%2f2015&DocID=A52996&bc=hAAAAAgAAAAAAA%3d%3d&. Accessed February 23, 2018.
Novitas Solutions, Inc. Local Coverage Determination (LCD). L35138: Routine foot care. [Novitas Solutions Web site]. 10/01/2015 (Revised 12/14/2017). Available at: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35138&ver=33&name=314*1&UpdatePeriod=696&bc=AQAAEAABAAAA&. Accessed February 23, 2018.
Pinzur MS, Slovenkai MP, Trepman E, Shields NN. Diabetes Committee of American Orthopaedic Foot and Ankle Society. Guidelines for diabetic foot care: recommendations endorsed by the Diabetes Committee of the American Orthopaedic Foot and Ankle Society. Foot Ankle Int. 2005;26(1):113-119.
Rathur HM, Boulton AJ. The diabetic foot. Clin Dermatol. 2007;25(1):109-120.
G0247 Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include if present, at least the following: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
S0390 Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (eg, diabetes), per visit
Q7 One Class A finding
Q8 Two Class B findings
Q9 One class B and 2 class C findings
Policy: 11.08.17h:Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Policy: 11.00.10u:Multiple Surgical Reduction Guidelines (Independence)