Page 277 - Medicare Benefit Policy Manual

Except as provided above, routine foot care is excluded from coverage. Services that
normally are considered routine and not covered by Medicare include the following:

• The cutting or removal of corns and calluses;

• The trimming, cutting, clipping, or debriding of nails; and

• Other hygienic and preventive maintenance care, such as cleaning and soaking
the feet, the use of skin creams to maintain skin tone of either ambulatory or
bedfast patients, and any other service performed in the absence of localized
illness, injury, or symptoms involving the foot.

3. Supportive Devices for Feet

Orthopedic shoes and other supportive devices for the feet generally are not covered.
However, this exclusion does not apply to such a shoe if it is an integral part of a leg
brace, and its expense is included as part of the cost of the brace. Also, this exclusion
does not apply to therapeutic shoes furnished to diabetics.

C. Exceptions to Routine Foot Care Exclusion

1. Necessary and Integral Part of Otherwise Covered Services

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.

2. Treatment of Warts on Foot

The treatment of warts (including plantar warts) on the foot is covered to the same extent
as services provided for the treatment of warts located elsewhere on the body.

3. Presence of Systemic Condition

The presence of a systemic condition such as metabolic, neurologic, or peripheral
vascular disease may require scrupulous foot care by a professional that in the absence of
such condition(s) would be considered routine (and, therefore, excluded from coverage).
Accordingly, foot care that would otherwise be considered routine may be covered when
systemic condition(s) result in severe circulatory embarrassment or areas of diminished
sensation in the individual’s legs or feet. (See subsection A.)

In these instances, certain foot care procedures that otherwise are considered routine (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 such
systemic conditions. (See §290.G for procedural instructions.)