Medicare Coverage of 'Routine' Foot Care
Generally speaking, Medicare does not pay for routine foot care. However, in certain circumstances, services ordinarily considered to be routine may be covered if:
- The service is performed as a necessary and essential part of otherwise covered services, such as the treatment of ulcers, wounds, or infections, or
- The presence of a ‘systemic condition’ -- such as metabolic, neurologic, or peripheral vascular disease -- may require foot care by a professional
In these instances, routine services (e.g., cutting or removing corns and calluses, or trimming, cutting, clipping, or debriding nails) may pose a hazard when performed by a nonprofessional person on patients with these types of symptoms.
Some of the common conditions that might justify routine foot care for a patient are diabetes, peripheral neuropathies, or occlusive peripheral arteriosclerosis. (This is not an all-inclusive list, and having these conditions does not guarantee Medicare payment. Requirements for medical necessity must be met.)
Patients receiving routine foot care due to ‘systemic’ conditions, as described above, should be followed by a primary care physician for that condition. In determining whether the routine services can be paid, the doctor’s records should show proof of specific physical and/or medical findings in keeping with the diagnosis.
Some foot symptoms, such as nail thickening, discoloration, shiny skin texture, absent pulse in certain sections of the leg and foot, temperature changes, such as excessively cold skin, or edema, may be present. (This, too, is not a complete list.)
If you have questions about your Railroad Medicare coverage for foot care services, you may contact our Beneficiary Contact Center at 800-833-4455, or for the hearing impaired, call TTY/TDD at 877-566-3572. Customer Service Representatives are available Monday through Friday, from 8:30 a.m. until 7 p.m. ET. We also encourage you to visit our Facebook page at www.Facebook.com/MyRRMedicare.