Page 280 - Medicare Benefit Policy Manual

Paresthesias (abnormal spontaneous sensations in the feet); and
Burning.

The presumption of coverage may be applied when the physician rendering the routine
foot care has identified:

1. A Class A finding;
2. Two of the Class B findings; or
3. One Class B and two Class C findings.

Cases evidencing findings falling short of these alternatives may involve podiatric
treatment that may constitute covered care and should be reviewed by the intermediary’s
medical staff and developed as necessary.

For purposes of applying the coverage presumption where the routine services have been
rendered by a podiatrist, the A/B MAC (B) may deem the active care requirement met if
the claim or other evidence available discloses that the patient has seen an M.D. or D.O.
for treatment and/or evaluation of the complicating disease process during the 6-month
period prior to the rendition of the routine-type services. The A/B MAC (A) may also
accept the podiatrist’s statement that the diagnosing and treating M.D. or D.O. also
concurs with the podiatrist’s findings as to the severity of the peripheral involvement
indicated.

Services ordinarily considered routine might also be covered if they are performed as a
necessary and integral part of otherwise covered services, such as diagnosis and treatment
of diabetic ulcers, wounds, and infections.

G. Application of Foot Care Exclusions to Physician’s Services

The exclusion of foot care is determined by the nature of the service. Thus, payment for
an excluded service should be denied whether performed by a podiatrist, osteopath, or a
doctor of medicine, and without regard to the difficulty or complexity of the procedure.

When an itemized bill shows both covered services and noncovered services not
integrally related to the covered service, the portion of charges attributable to the
noncovered services should be denied. (For example, if an itemized bill shows surgery
for an ingrown toenail and also removal of calluses not necessary for the performance of
toe surgery, any additional charge attributable to removal of the calluses should be
denied.)

In reviewing claims involving foot care, the A/B MAC (B) should be alert to the
following exceptional situations:

1. Payment may be made for incidental noncovered services performed as a
necessary and integral part of, and secondary to, a covered procedure. For
example, if trimming of toenails is required for application of a cast to a fractured