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February 4, 2020

Updated Podiatry Edits

CGS Administrators has been made aware of an issue in claims denying in error concerning debridement of mycotic nails needing a class finding modifier. This issue began January 16, 2020. As indicated in the IOM 100-02 Chapter 15 section 290 and policy L34246 Routine Foot Care and Debridement of Nails a class finding modifier is not required for the debridement of mycotic nails with either pain or infection; or evidence of neuropathy with no vascular impairment.

We would like to thank the provider community for bringing this to our attention and we are working on getting the issue corrected in our system. Once the system is corrected CGS will identify claims denied in error and adjust the claims. Please watch our website for updates concerning this issue.

Note: CGS has corrected our system issue concerning podiatry edits and is in the process of identifying claims denied in error.

For more information on these services and the class finding modifiers:

Additional references may be found in the CMS Internet Only Manual:

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