Billing and Coding Article

Billing and Coding: Foot Care

A56232

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Contractor Information

Contractor Name	Contract Type	Contract Number	Jurisdiction	States
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	05101 - MAC A	J - 05	Iowa
Wisconsin Physicians Service Insurance Corporation	MAC - Part B	05102 - MAC B	J - 05	Iowa
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	05201 - MAC A	J - 05	Kansas
Wisconsin Physicians Service Insurance Corporation	MAC - Part B	05202 - MAC B	J - 05	Kansas
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	05301 - MAC A	J - 05	Missouri - Entire State
Wisconsin Physicians Service Insurance Corporation	MAC - Part B	05302 - MAC B	J - 05	Missouri - Entire State
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	05401 - MAC A	J - 05	Nebraska
Wisconsin Physicians Service Insurance Corporation	MAC - Part B	05402 - MAC B	J - 05	Nebraska
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	05901 - MAC A	J - 05	Alabama Alaska Arizona Arkansas California - Entire State Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi Missouri - Entire State Montana Nebraska Nevada New Hampshire New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	08101 - MAC A	J - 08	Indiana
Wisconsin Physicians Service Insurance Corporation	MAC - Part B	08102 - MAC B	J - 08	Indiana
Wisconsin Physicians Service Insurance Corporation	MAC - Part A	08201 - MAC A	J - 08	Michigan
Wisconsin Physicians Service Insurance Corporation	MAC - Part B	08202 - MAC B	J - 08	Michigan

Article Information

General Information

Article ID
A56232

Article Title
Billing and Coding: Foot Care

Article Type
Billing and Coding

Original Effective Date
02/16/2019

Revision Effective Date
01/01/2024

Revision Ending Date
N/A

Retirement Date
N/A

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CMS National Coverage Policy

CMS Publication, IOM 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 290 – Foot Care

CMS Publication IOM 100-03 Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, Coverage Determinations, Section 70.2.1 Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy)

42 CFR § 411.15 - Particular services excluded from coverage (l) Foot care

Article Guidance

Article Text

Routine foot care is usually performed by the beneficiary himself or herself, or by a caregiver.
Generally, routine foot care is excluded from coverage. Services that normally are considered routine and not covered by Medicare can be found in Publication Number 100-02 Medicare Benefit Policy Manual, Chapter 15 Covered Medical and Other Health Services, Section 290.2 Routine Foot Care. WPS GHA would also include the shaving, paring, cutting, or removal of keratoma, tyloma, and heloma as routine foot care excluded from coverage.

Indications
Routine foot care services are subject to national regulations, which provides definitions, indications, and limitations for Medicare payment of routine foot care services.

Medicare Benefit Policy Manual (Pub. 100-02), Chapter 15, Section 290 describes exceptions to routine foot care exclusions.
WPS GHA includes mycotic nails with the following exceptions to routine foot care exclusions:

In the presence of systemic conditions such as metabolic, neurologic, and peripheral vascular diseases.
In the absence of systemic conditions:
1. Ambulatory patient must have marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of infected toenail plate.
2. Non-ambulatory patient suffers from pain or secondary infection resulting from the thickening and dystrophy of infected toenail plate.

Systemic Conditions
Foot care services are covered in the presence of a systemic condition. Refer to the Medicare Benefit Policy Publication 100-02, Chapter 15, Section 290.4 D Systemic Conditions That Might Justify Coverage for a list of systemic conditions. For diagnosis codes designated by an asterisk (*), it is required the patient be under the active care of Doctor of Osteopathic Medicine (D.O.) or Doctor of Medicine (M.D.) The active care requirement would be considered met if the claim indicates that the patient has seen an M.D. or D.O. for treatment and/or evaluation of the complicating disease process during the 6-month period prior to the service. A list of diagnosis codes can be found in Group 1 Paragraph under ICD-10 Codes that Support Medical Necessity.

Presumption of Coverage
Refer to the Medicare Benefit Policy Publication 100-02, Chapter 15, Section 290.4 D. for a list of conditions with a presumption of coverage for routine services.

In addition to a valid billing modifier, these services must include a systemic condition diagnosis listed in IOM 100-02, Chapter 15, Section 290 and in Group 1 of the diagnosis codes. All claims for routine foot care based on the presence of a systemic condition must have a billing modifier of Q7, Q8, or Q9 to be considered for payment.

Mycotic Nails

Mycotic nail debridement may be a covered service:

In the presence of a systemic disease with the class findings and appropriate Q modifier.
In the absence of systemic disease if the patient has mycotic nails and marked limitation of ambulation, pain, or secondary infection resulting from the thickening and dystrophy of infected toenail plate.
In the absence of systemic disease when a non-ambulatory patient has mycotic nails and suffers from pain or secondary infection resulting from the thickening and dystrophy of infected toenail plate.

For services without systemic disease and class findings, the diagnosis in Group 2 and Group 3 of the diagnosis codes below must be documented in the medical record and submitted on the claim.

The nail debridement procedure codes are considered non-covered routine foot care when these services do not meet the guidelines outlined above for mycotic nail services.

Limitations

Covered exceptions to routine foot care services are considered medically necessary once (1) in 60 days. More frequent services will be denied as not reasonable and necessary.
The exclusion of foot care is determined by the nature of the service, regardless of the clinician who performs the service.
Medicare allows payment for routine foot care only if the conditions under indications are met. These conditions describe the systemic diseases and their peripheral complications that increase the danger for infection and injury if a non-professional provides these services.
Services not meeting the criteria in this statement of national coverage will be denied as statutory non-covered services. For diagnosis codes designated by an asterisk (*), we will require the date the patient was last seen (DPLS) and the NPI of the Doctor of Medicine or Doctor of Osteopathic Medicine actively managing the patient’s systemic condition.
Nail debridement procedures are considered non-covered routine foot care when these services do not meet the guidelines outlined above for mycotic nail services or are not based on the presence of a systemic condition. If the nail debridement procedures are performed in the absence of mycotic nails and as part of foot care, they must meet the same criteria as all other routine foot care services to be considered for payment.
Foot care services that do not require a professional would be considered routine and not a Medicare benefit. Professional in this situation is defined as an M.D., D.O., D.P.M., Nurse Practitioner, Clinical Nurse Specialist, or Physician Assistant.
A Registered Nurse that holds foot care certification (CFCN®) may perform covered foot care services when all the following requirements are met:
- Services are performed under direct supervision of a physician or other practitioner
- All requirements of the “incident to” provision are met per the CMS Medicare Benefit Policy Manual
- Proof of accredited Foot Care Nurse certification must be included in the documentation
- All other coverage provisions outlined in this Billing and Coding Article are met

Loss of protective sensation (LOPS) is not the subject of this coverage article. Please refer to CMS Publication, 100-03, Medicare National Coverage Determination Manual 70.2.1 “Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy)”.

General Information
Documentation Requirements
Documentation in the medical record must support the services as billed, meet the criteria in the indications section above, and be available upon request.

Utilization Guidelines
Review Benefit Policy Manual (Pub. 100-02), Chapter 15, Section 290 G. Application of Foot Care Exclusions to Physician’s Services for an explanation of situations that would require medical record review.

Services performed for a localized condition that created a painful condition/complication that could not be otherwise managed by the patient and would place the patient at risk if not performed by a professional, would require medical record review.

Services for debridement of more than five nails in a single day may be subject to medical review.

Response To Comments

Number	Comment	Response
1

Coding Information

CPT/HCPCS Codes

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Group 1

(7 Codes)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
11055	PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION
11056	PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); 2 TO 4 LESIONS
11057	PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE THAN 4 LESIONS
11719	TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
11720	DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5
11721	DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 6 OR MORE
G0127	TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER

CPT/HCPCS Modifiers

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Group 1

(3 Codes)

Group 1 Paragraph

N/A

Group 1 Codes

Code	Description
Q7	ONE CLASS A FINDING
Q8	TWO CLASS B FINDINGS
Q9	ONE CLASS B AND TWO CLASS C FINDINGS

ICD-10-CM Codes that Support Medical Necessity

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Group 1

(773 Codes)

Group 1 Paragraph

For codes 11055, 11056, 11057, 11719, 11720, 11721, G0127 billed with modifier Q7, Q8 or Q9. *The following diagnosis codes also need the date last seen and name and NPI of the attending physician: D51.0, E08.00-E13.9, E46, E52, E56.9, E64.0, G13.0, G35, G60.0, G60.2, G62.1, G62.82, G63, I80.01, I80.02, I80.03, K90.0, K90.1, N18.1, N18.2, N18.30, N18.31, N18.32, N18.4, N18.5, N18.6, and N18.9.

For the codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter or S sequela may be used.

Group 1 Codes

Code	Description
A30.0	Indeterminate leprosy
A30.1	Tuberculoid leprosy
A30.2	Borderline tuberculoid leprosy
A30.3	Borderline leprosy
A30.4	Borderline lepromatous leprosy
A30.5	Lepromatous leprosy
A30.8	Other forms of leprosy
A30.9	Leprosy, unspecified
A52.10	Symptomatic neurosyphilis, unspecified
A52.11	Tabes dorsalis
A52.12	Other cerebrospinal syphilis
A52.13	Late syphilitic meningitis
A52.14	Late syphilitic encephalitis
A52.15	Late syphilitic neuropathy
A52.16	Charcot's arthropathy (tabetic)
A52.17	General paresis
A52.19	Other symptomatic neurosyphilis
A52.2	Asymptomatic neurosyphilis
A52.3	Neurosyphilis, unspecified
D51.0	Vitamin B12 deficiency anemia due to intrinsic factor deficiency
E08.00 - E13.9	Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) - Other specified diabetes mellitus without complications
E46	Unspecified protein-calorie malnutrition
E52	Niacin deficiency [pellagra]
E56.9	Vitamin deficiency, unspecified
E64.0	Sequelae of protein-calorie malnutrition
E75.21	Fabry (-Anderson) disease
E75.22	Gaucher disease
E75.240	Niemann-Pick disease type A
E75.241	Niemann-Pick disease type B
E75.242	Niemann-Pick disease type C
E75.243	Niemann-Pick disease type D
E75.244	Niemann-Pick disease type A/B
E75.248	Other Niemann-Pick disease
E75.249	Niemann-Pick disease, unspecified
E75.27	Pelizaeus-Merzbacher disease
E75.28	Canavan disease
E75.3	Sphingolipidosis, unspecified
E77.0	Defects in post-translational modification of lysosomal enzymes
E77.1	Defects in glycoprotein degradation
E77.8	Other disorders of glycoprotein metabolism
E77.9	Disorder of glycoprotein metabolism, unspecified
E85.0	Non-neuropathic heredofamilial amyloidosis
E85.1	Neuropathic heredofamilial amyloidosis
E85.2	Heredofamilial amyloidosis, unspecified
E85.3	Secondary systemic amyloidosis
E85.4	Organ-limited amyloidosis
E85.81	Light chain (AL) amyloidosis
E85.82	Wild-type transthyretin-related (ATTR) amyloidosis
E85.89	Other amyloidosis
E85.9	Amyloidosis, unspecified
G13.0	Paraneoplastic neuromyopathy and neuropathy
G13.1	Other systemic atrophy primarily affecting central nervous system in neoplastic disease
G35	Multiple sclerosis
G60.0	Hereditary motor and sensory neuropathy
G60.1	Refsum's disease
G60.2	Neuropathy in association with hereditary ataxia
G60.3	Idiopathic progressive neuropathy
G60.8	Other hereditary and idiopathic neuropathies
G60.9	Hereditary and idiopathic neuropathy, unspecified
G61.1	Serum neuropathy
G62.0	Drug-induced polyneuropathy
G62.1	Alcoholic polyneuropathy
G62.2	Polyneuropathy due to other toxic agents
G62.82	Radiation-induced polyneuropathy
G63	Polyneuropathy in diseases classified elsewhere
G65.0	Sequelae of Guillain-Barre syndrome
G65.1	Sequelae of other inflammatory polyneuropathy
G65.2	Sequelae of toxic polyneuropathy
I70.201	Unspecified atherosclerosis of native arteries of extremities, right leg
I70.202	Unspecified atherosclerosis of native arteries of extremities, left leg
I70.203	Unspecified atherosclerosis of native arteries of extremities, bilateral legs
I70.211	Atherosclerosis of native arteries of extremities with intermittent claudication, right leg
I70.212	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg
I70.213	Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs
I70.221	Atherosclerosis of native arteries of extremities with rest pain, right leg
I70.222	Atherosclerosis of native arteries of extremities with rest pain, left leg
I70.223	Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
I70.231	Atherosclerosis of native arteries of right leg with ulceration of thigh
I70.232	Atherosclerosis of native arteries of right leg with ulceration of calf
I70.233	Atherosclerosis of native arteries of right leg with ulceration of ankle
I70.234	Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot
I70.235	Atherosclerosis of native arteries of right leg with ulceration of other part of foot
I70.238	Atherosclerosis of native arteries of right leg with ulceration of other part of lower leg
I70.239	Atherosclerosis of native arteries of right leg with ulceration of unspecified site
I70.241	Atherosclerosis of native arteries of left leg with ulceration of thigh
I70.242	Atherosclerosis of native arteries of left leg with ulceration of calf
I70.243	Atherosclerosis of native arteries of left leg with ulceration of ankle
I70.244	Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot
I70.245	Atherosclerosis of native arteries of left leg with ulceration of other part of foot
I70.248	Atherosclerosis of native arteries of left leg with ulceration of other part of lower leg
I70.249	Atherosclerosis of native arteries of left leg with ulceration of unspecified site
I70.261	Atherosclerosis of native arteries of extremities with gangrene, right leg
I70.262	Atherosclerosis of native arteries of extremities with gangrene, left leg
I70.263	Atherosclerosis of native arteries of extremities with gangrene, bilateral legs
I70.291	Other atherosclerosis of native arteries of extremities, right leg
I70.292	Other atherosclerosis of native arteries of extremities, left leg
I70.293	Other atherosclerosis of native arteries of extremities, bilateral legs
I70.301	Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg
I70.302	Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg
I70.303	Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs
I70.311	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.312	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.313	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.321	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg
I70.322	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg
I70.323	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.331	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of thigh
I70.332	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of calf
I70.333	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of ankle
I70.334	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.335	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.338	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.339	Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of unspecified site
I70.341	Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of thigh
I70.342	Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of calf
I70.343	Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of ankle
I70.344	Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.345	Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.348	Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.361	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, right leg
I70.362	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, left leg
I70.363	Atherosclerosis of unspecified type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.391	Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg
I70.392	Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg
I70.393	Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs
I70.401	Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.402	Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.403	Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.411	Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg
I70.412	Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg
I70.413	Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.421	Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
I70.422	Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg
I70.423	Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs
I70.431	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of thigh
I70.432	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf
I70.433	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of ankle
I70.434	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.435	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot
I70.438	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.439	Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of unspecified site
I70.441	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of thigh
I70.442	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of calf
I70.443	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of ankle
I70.444	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.445	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot
I70.448	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.449	Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of unspecified site
I70.461	Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, right leg
I70.462	Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, left leg
I70.463	Atherosclerosis of autologous vein bypass graft(s) of the extremities with gangrene, bilateral legs
I70.491	Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg
I70.492	Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg
I70.493	Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs
I70.501	Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.502	Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.503	Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.511	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.512	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.513	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.521	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg
I70.522	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg
I70.523	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.531	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of thigh
I70.532	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of calf
I70.533	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of ankle
I70.534	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.535	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot
I70.538	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.539	Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of unspecified site
I70.541	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of thigh
I70.542	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of calf
I70.543	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of ankle
I70.544	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.545	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot
I70.548	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.549	Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of unspecified site
I70.561	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, right leg
I70.562	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, left leg
I70.563	Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.591	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg
I70.592	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg
I70.593	Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs
I70.601	Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.602	Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.603	Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.611	Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg
I70.612	Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg
I70.613	Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.621	Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg
I70.622	Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg
I70.623	Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs
I70.631	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of thigh
I70.632	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of calf
I70.633	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of ankle
I70.634	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.635	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot
I70.638	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.639	Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of unspecified site
I70.641	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of thigh
I70.642	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of calf
I70.643	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of ankle
I70.644	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.645	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot
I70.648	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.649	Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of unspecified site
I70.661	Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, right leg
I70.662	Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, left leg
I70.663	Atherosclerosis of nonbiological bypass graft(s) of the extremities with gangrene, bilateral legs
I70.691	Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg
I70.692	Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg
I70.693	Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs
I70.701	Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.702	Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.703	Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I70.711	Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg
I70.712	Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg
I70.713	Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs
I70.721	Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg
I70.722	Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg
I70.723	Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs
I70.731	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of thigh
I70.732	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of calf
I70.733	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of ankle
I70.734	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot
I70.735	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot
I70.738	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of lower leg
I70.739	Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of unspecified site
I70.741	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of thigh
I70.742	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of calf
I70.743	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of ankle
I70.744	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot
I70.745	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot
I70.748	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of lower leg
I70.749	Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of unspecified site
I70.761	Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, right leg
I70.762	Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, left leg
I70.763	Atherosclerosis of other type of bypass graft(s) of the extremities with gangrene, bilateral legs
I70.791	Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg
I70.792	Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg
I70.793	Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs
I70.8	Atherosclerosis of other arteries
I70.90	Unspecified atherosclerosis
I70.91	Generalized atherosclerosis
I70.92	Chronic total occlusion of artery of the extremities
I73.00	Raynaud's syndrome without gangrene
I73.01	Raynaud's syndrome with gangrene
I73.1	Thromboangiitis obliterans [Buerger's disease]
I73.9	Peripheral vascular disease, unspecified
I79.0	Aneurysm of aorta in diseases classified elsewhere
I80.01	Phlebitis and thrombophlebitis of superficial vessels of right lower extremity
I80.02	Phlebitis and thrombophlebitis of superficial vessels of left lower extremity
I80.03	Phlebitis and thrombophlebitis of superficial vessels of lower extremities, bilateral
I80.11	Phlebitis and thrombophlebitis of right femoral vein
I80.12	Phlebitis and thrombophlebitis of left femoral vein
I80.13	Phlebitis and thrombophlebitis of femoral vein, bilateral
I80.201	Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity
I80.202	Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity
I80.203	Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral
I80.211	Phlebitis and thrombophlebitis of right iliac vein
I80.212	Phlebitis and thrombophlebitis of left iliac vein
I80.213	Phlebitis and thrombophlebitis of iliac vein, bilateral
I80.221	Phlebitis and thrombophlebitis of right popliteal vein
I80.222	Phlebitis and thrombophlebitis of left popliteal vein
I80.223	Phlebitis and thrombophlebitis of popliteal vein, bilateral
I80.231	Phlebitis and thrombophlebitis of right tibial vein
I80.232	Phlebitis and thrombophlebitis of left tibial vein
I80.233	Phlebitis and thrombophlebitis of tibial vein, bilateral
I80.241	Phlebitis and thrombophlebitis of right peroneal vein
I80.242	Phlebitis and thrombophlebitis of left peroneal vein
I80.243	Phlebitis and thrombophlebitis of peroneal vein, bilateral
I80.251	Phlebitis and thrombophlebitis of right calf muscular vein
I80.252	Phlebitis and thrombophlebitis of left calf muscular vein
I80.253	Phlebitis and thrombophlebitis of calf muscular vein, bilateral
I80.291	Phlebitis and thrombophlebitis of other deep vessels of right lower extremity
I80.292	Phlebitis and thrombophlebitis of other deep vessels of left lower extremity
I80.293	Phlebitis and thrombophlebitis of other deep vessels of lower extremity, bilateral
I80.3	Phlebitis and thrombophlebitis of lower extremities, unspecified
K90.0	Celiac disease
K90.1	Tropical sprue
M34.83	Systemic sclerosis with polyneuropathy
N18.1	Chronic kidney disease, stage 1
N18.2	Chronic kidney disease, stage 2 (mild)
N18.30	Chronic kidney disease, stage 3 unspecified
N18.31	Chronic kidney disease, stage 3a
N18.32	Chronic kidney disease, stage 3b
N18.4	Chronic kidney disease, stage 4 (severe)
N18.5	Chronic kidney disease, stage 5
N18.6	End stage renal disease
N18.9	Chronic kidney disease, unspecified
S86.001A	Unspecified injury of right Achilles tendon, initial encounter
S86.002A	Unspecified injury of left Achilles tendon, initial encounter
S86.091A	Other specified injury of right Achilles tendon, initial encounter
S86.092A	Other specified injury of left Achilles tendon, initial encounter
S86.101A	Unspecified injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, initial encounter
S86.102A	Unspecified injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, left leg, initial encounter
S86.191A	Other injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, right leg, initial encounter
S86.192A	Other injury of other muscle(s) and tendon(s) of posterior muscle group at lower leg level, left leg, initial encounter
S86.201A	Unspecified injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, initial encounter
S86.202A	Unspecified injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, initial encounter
S86.291A	Other injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level, right leg, initial encounter
S86.292A	Other injury of muscle(s) and tendon(s) of anterior muscle group at lower leg level, left leg, initial encounter
S86.301A	Unspecified injury of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, initial encounter
S86.302A	Unspecified injury of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, initial encounter
S86.391A	Other injury of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, right leg, initial encounter
S86.392A	Other injury of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, initial encounter
S86.801A	Unspecified injury of other muscle(s) and tendon(s) at lower leg level, right leg, initial encounter
S86.802A	Unspecified injury of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
S86.891A	Other injury of other muscle(s) and tendon(s) at lower leg level, right leg, initial encounter
S86.892A	Other injury of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
S86.901A	Unspecified injury of unspecified muscle(s) and tendon(s) at lower leg level, right leg, initial encounter
S86.902A	Unspecified injury of unspecified muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
S86.991A	Other injury of unspecified muscle(s) and tendon(s) at lower leg level, right leg, initial encounter
S86.992A	Other injury of unspecified muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
S89.81XA	Other specified injuries of right lower leg, initial encounter
S89.82XA	Other specified injuries of left lower leg, initial encounter
S89.91XA	Unspecified injury of right lower leg, initial encounter
S89.92XA	Unspecified injury of left lower leg, initial encounter
S96.001A	Unspecified injury of muscle and tendon of long flexor muscle of toe at ankle and foot level, right foot, initial encounter
S96.002A	Unspecified injury of muscle and tendon of long flexor muscle of toe at ankle and foot level, left foot, initial encounter
S96.091A	Other injury of muscle and tendon of long flexor muscle of toe at ankle and foot level, right foot, initial encounter
S96.092A	Other injury of muscle and tendon of long flexor muscle of toe at ankle and foot level, left foot, initial encounter
S96.101A	Unspecified injury of muscle and tendon of long extensor muscle of toe at ankle and foot level, right foot, initial encounter
S96.102A	Unspecified injury of muscle and tendon of long extensor muscle of toe at ankle and foot level, left foot, initial encounter
S96.191A	Other specified injury of muscle and tendon of long extensor muscle of toe at ankle and foot level, right foot, initial encounter
S96.192A	Other specified injury of muscle and tendon of long extensor muscle of toe at ankle and foot level, left foot, initial encounter
S96.201A	Unspecified injury of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter
S96.202A	Unspecified injury of intrinsic muscle and tendon at ankle and foot level, left foot, initial encounter
S96.291A	Other specified injury of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter
S96.292A	Other specified injury of intrinsic muscle and tendon at ankle and foot level, left foot, initial encounter
S96.801A	Unspecified injury of other specified muscles and tendons at ankle and foot level, right foot, initial encounter
S96.802A	Unspecified injury of other specified muscles and tendons at ankle and foot level, left foot, initial encounter
S96.891A	Other specified injury of other specified muscles and tendons at ankle and foot level, right foot, initial encounter
S96.892A	Other specified injury of other specified muscles and tendons at ankle and foot level, left foot, initial encounter
S96.901A	Unspecified injury of unspecified muscle and tendon at ankle and foot level, right foot, initial encounter
S96.902A	Unspecified injury of unspecified muscle and tendon at ankle and foot level, left foot, initial encounter
S96.991A	Other specified injury of unspecified muscle and tendon at ankle and foot level, right foot, initial encounter
S96.992A	Other specified injury of unspecified muscle and tendon at ankle and foot level, left foot, initial encounter
S99.811A	Other specified injuries of right ankle, initial encounter
S99.812A	Other specified injuries of left ankle, initial encounter
S99.821A	Other specified injuries of right foot, initial encounter
S99.822A	Other specified injuries of left foot, initial encounter
S99.911A	Unspecified injury of right ankle, initial encounter
S99.912A	Unspecified injury of left ankle, initial encounter
S99.921A	Unspecified injury of right foot, initial encounter
S99.922A	Unspecified injury of left foot, initial encounter

Group 2

(1 Code)

Group 2 Paragraph

Codes 11720 and 11721 billed without a Q modifier require a code from group 2 (clinical evidence of mycosis of the nail) and a code from group 3.

Group 2 Codes

Code	Description
B35.1	Tinea unguium

Group 3

(11 Codes)

Group 3 Paragraph

Codes 11720 and 11721 billed without a Q modifier require a code from group 2 (clinical evidence of mycosis of the nail) and a code from group 3 (pain or secondary infection).

Group 3 Codes

Code	Description
L02.611	Cutaneous abscess of right foot
L02.612	Cutaneous abscess of left foot
L03.031	Cellulitis of right toe
L03.032	Cellulitis of left toe
L03.041	Acute lymphangitis of right toe
L03.042	Acute lymphangitis of left toe
M79.671	Pain in right foot
M79.672	Pain in left foot
M79.674	Pain in right toe(s)
M79.675	Pain in left toe(s)
R26.2	Difficulty in walking, not elsewhere classified

ICD-10-CM Codes that DO NOT Support Medical Necessity

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Group 1

Group 1 Paragraph

Codes not listed above

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion
			N/A	N/A

Non-Excluded CPT/HCPCS Ended Codes - Table Format

Code	Descriptor Generic Name	Descriptor Brand Name	Exclusion Effective Date	Exclusion End Date	Reason for Exclusion

Revision History Information

Revision History Date	Revision History Number	Revision History Explanation
01/01/2024	R10	Posted 02/01/2024: Under Coding Information CPT/HCPCS Codes Group 1 Codes, the following codes had a description change: 11055, 11056, 11057. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is effective 01/01/2024.
10/01/2023	R9	Posted 09/28/2023: Under ICD-10-CM Codes that Support Medical Necessity Group 1 Codes, added E75.27 and E75.28. This revision is due to the 2024 Annual ICD-10-CM Code Updates and is effective 10/01/2023.
10/27/2022	R8	Posted 10/27/2022: Review completed with no change in coverage. Minor grammar and punctuation corrections made throughout the article.
06/30/2022	R7	Posted 06/30/2022: Under Limitations, added the following statement: A Registered Nurse that holds foot care certification (CFCN®) may perform covered foot care services when all the following requirements are met: Services are performed under direct supervision of a physician or other practitioner All requirements of the “incident to” provision are met per the CMS Medicare Benefit Policy Manual Proof of accredited Foot Care Nurse certification must be included in the documentation All other coverage provisions outlined in this Billing and Coding Article are met
10/01/2021	R6	09/30/2021 ICD-10 CM Code Updates: Under ICD-10 Codes that Support Medical Necessity, added E75.244 to Group 1 Codes.
11/26/2020	R5	11/26/2020 Group 1 Paragraph: Deleted N18.3 and added N18.30, N18.31, and N18.32. Changed Doctor of Osteopathy to Doctor of Osteopathic Medicine. Review completed 11/04/2020 with no change in coverage. Format revision completed.
10/01/2020	R4	10/01/2020 ICD-10-CM Code Updates to Group 1: Deleted N18.3 and added N18.30, N18.31, and N18.32. Format change completed.
11/01/2019	R3	11/01/2019 Added referenced information to CMS National Coverage Policy. Content has been moved to the new template.
10/01/2019	R2	09/26/2019 ICD-10-CM Code Updates to Group 1: Added I80.241, I80.242, I80.243, I80.251, I80.252, and I80.253, with Description Change to I70.238 and I70.248. Review completed 08/30/2019.
02/16/2019	R1	02/01/2019 Added asterisk (*) to second sentence in Group 1 Paragraph for clarification.

Associated Documents

Updated On	Effective Dates	Status
01/23/2024	01/01/2024 - N/A	Currently in Effect	You are here
09/19/2023	10/01/2023 - 12/31/2023	Superseded	View
10/18/2022	10/27/2022 - 09/30/2023	Superseded	View
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Billing and Coding: Foot Care

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ICD-10-CM Codes that Support Medical Necessity

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ICD-10-CM Codes that DO NOT Support Medical Necessity

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