**Abstract:**  
  
The Medicare program generally does not cover routine foot care. However, this
determination and the related Billing and Coding article outline the specific
conditions for which coverage may be allowed.

**Indications:**  
  
While the Medicare program generally excludes routine foot care services from
coverage, there are specific indications or exceptions under which there are
program benefits.  
  
Medicare payment may be made for routine foot care when the patient has a
systemic disease, such as metabolic, neurologic, or peripheral vascular
disease, of sufficient severity that performance of such services by a
nonprofessional person would put the patient at risk (for example, a systemic
condition that has resulted in severe circulatory embarrassment or areas of
desensitization in the patient's legs or feet).  
  
Treatment of mycotic nails may be covered under the exceptions to the routine
foot care exclusion. The class findings, or the presence of qualifying
systemic illnesses causing a peripheral neuropathy, must be present. Please
refer to the related Billing and Coding article for coverage criteria.  
  
In addition, procedures for treating toenails are covered for the following:  
  
Onychogryphosis (defined as long-standing thickening, in which typically a
curved hooked nail [ram's horn nail] occurs), and there is marked limitation
of ambulation, pain, and/or secondary infection where the nail plate is
causing symptomatic indentation of or minor laceration of the affected distal
toe; and/or  
  
Onychauxis (defined as a thickening [hypertrophy] of the base of the nail/nail
bed) and there is marked limitation of ambulation, pain, and/or secondary
infection that causes symptoms.  
  
The physical and clinical findings, which are indicative of severe peripheral
involvement, must be documented and maintained in the patient record, in order
for routine foot care services to be reimbursable. Refer to the related
Billing and Coding article for Class Findings. _  
  
_Note: Benefits for routine foot care are also available for patients with
peripheral neuropathy involving the feet, but without the vascular impairment
outlined in Class B findings. The neuropathy should be of such severity that
care by a non-professional person would put the patient at risk. If the
patient has evidence of neuropathy but no vascular impairment, the use of
class findings modifiers is not necessary. This condition would be represented
by the ICD-10-CM codes in Group  4 of the "ICD-10-CM Codes that Support
Medical Necessity" section in the related Billing and Coding article.  _  
  
_ **Limitations:** _  
  
_When the patient's condition is designated by an ICD-10-CM code with an
asterisk (*) (see ICD-10-CM Codes That Support Medical Necessity in the
related article), routine foot care procedures are reimbursable only if the
patient is under the active care of a doctor of medicine or osteopathy (MD or
DO) for the treatment and/or evaluation of the complicating disease process
during the six (6) month period prior to the rendition of the routine-type
service. _  
  
_ **Other Comments:**  
  
Medicare does not routinely cover fungus cultures and KOH preparations
performed on toenail clippings in the doctor's office. Identification of
cultures of fungi in the toenail clippings is medically necessary only:

When it is required to differentiate fungal disease from psoriatic nails.

When a definitive treatment for a prolonged period of time is being planned
involving the use of a prescription medication.