LCD Reference Article Article

Coverage of Foot Care Services

A52918

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
NOT AN LCD REFERENCE ARTICLE
This article is not in direct support of an LCD.

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General Information

Source Article ID
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Article ID
A52918
Original ICD-9 Article ID
Not Applicable
Article Title
Coverage of Foot Care Services
Article Type
Article
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2015
Revision Ending Date
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Retirement Date
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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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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CMS National Coverage Policy

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Article Guidance

Article Text
Noridian has noted, through Medical Review, billing of foot care services as non-covered when documentation supports the patient has complaints of associated foot pain. The purpose of this educational article is to clarify coverage of foot care services related to pain.

The Medicare Benefit Policy Manual (MBPM) Chapter 15 section 290.C.1 (http://www.cms.hhs.gov) states, "In certain circumstances, 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." In this regard, foot care services associated with a patient's complaints of pain would not be considered routine in nature. Pain may indicate a problem, such as an ulcer or infection, which is necessary to evaluate. If pain is associated with the reason for the foot care, it is reasonable and necessary for the medical professional to assess and evaluate the pain, and subsequently treat both the pain and the cause of the pain if possible.

For all other covered indications for foot care services, including presumption of coverage guidelines, as well as foot care excluded from Medicare coverage, refer to the MBPM Chapter 15 section 290.

Source:
Medicare Benefit Policy Manual (MBPM) Chapter 15 section 290
Social Security Act (SSA) Title XVIII section 1862(a)(1)(A)

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Coding Information

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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.

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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.

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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2015 R1

Updated to indicate this article is not an LCD Reference Article

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Public Versions
Updated On Effective Dates Status
11/22/2023 10/01/2015 - N/A Currently in Effect You are here
03/31/2014 10/01/2015 - N/A Superseded View

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