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Foot Care under the Home Health Benefit

Q: Under what circumstances would foot and nail care be covered by Medicare under the home health benefit?

A: The Medicare Benefit Policy Manual (Pub. 100-02, Ch. 16, §30 External PDF) states that "Some foot care is excluded and some is covered. A description of both is in Chapter 15, §290 External PDF." The information in Pub. 100-02, Ch. 15, § 290 External PDF, details what is required for footcare/toenail trimming to be "skilled" and "coverable". Routine foot care may become skilled and coverable if the beneficiary has one of the listed systemic conditions such as diabetes, enough of the listed class findings, and require the actual trimming of the nails. Please see the information in §290 B.2, §290 C.3, §290 D & F which lists the systemic conditions and class findings that may support the need for skilled foot care.

What Medicare Covers IF… Active Physician Care Required?? Systemic Conditions (That might justify coverage) What's Not Covered

According to the 'Medicare Benefit Policy Manual', Chapter 15, Section 290, Medicare covered foot care services only include medically necessary and reasonable foot care.

Deemed within the doctor's of medicine or osteopathy, which includes podiatrists, scope of practice & the foot care is related to underlying systemic conditions such as metabolic, neurologic or peripheral vascular disease, or injury, ulcers, wounds, and infections.

YES, with supporting documentation.

Please note that asterisked diagnoses require the physician to document the condition.

Although not intended as a comprehensive list, the following metabolic, neurologic, and peripheral vascular diseases (with synonyms in parentheses) most commonly represent the underlying conditions that might justify coverage for routine foot care.

  • Diabetes mellitus *
  • Arteriosclerosis obliterans (A.S.O., arteriosclerosis of the extremities, occlusive peripheral arteriosclerosis)
  • Buerger's disease (thromboangiitis obliterans)
  • Chronic thrombophlebitis *
  • Peripheral neuropathies involving the feet
    • Associated with malnutrition and vitamin deficiency *
      • Malnutrition (general, pellagra)
      • Alcoholism
      • Malabsorption (celiac disease, tropical sprue)
      • Pernicious anemia
    • Associated with carcinoma *
    • Associated with diabetes mellitus *
    • Associated with drugs and toxins *
    • Associated with multiple sclerosis *
    • Associated with uremia (chronic renal disease) *
    • Associated with traumatic injury
    • Associated with leprosy or neurosyphilis
    • Associated with hereditary disorders
      • Hereditary sensory radicular neuropathy
      • Angiokeratoma corporis diffusum (Fabry's)
      • Amyloid neuropathy

Routine Foot Care*

Flat Foot Conditions

Treatment of Subluxation of Foot*

  • * Indicates exceptions may apply
  • When the patient's condition is one of those designated above by an asterisk (*), routine procedures are covered only if the patient is under the active care of a doctor of medicine or osteopathy who documents the condition.

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Updated: 12.11.14

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