Page 281 - Medicare Benefit Policy Manual

foot, the A/B MAC (B) need not allocate and deny a portion of the charge for the
trimming of the nails. However, a separately itemized charge for such excluded
service should be disallowed. When the primary procedure is covered the
administration of anesthesia necessary for the performance of such procedure is
also covered.

2. Payment may be made for initial diagnostic services performed in connection
with a specific symptom or complaint if it seems likely that its treatment would be
covered even though the resulting diagnosis may be one requiring only
noncovered care.

The name of the M.D. or D.O. who diagnosed the complicating condition must be
submitted with the claim. In those cases, where active care is required, the approximate
date the beneficiary was last seen by such physician must also be indicated.

NOTE: Section 939 of P.L. 96-499 removed “warts” from the routine foot care
exclusion effective July 1, 1981.

Relatively few claims for routine-type care are anticipated considering the severity of
conditions contemplated as the basis for this exception. Claims for this type of foot care
should not be paid in the absence of convincing evidence that nonprofessional
performance of the service would have been hazardous for the beneficiary because of an
underlying systemic disease. The mere statement of a diagnosis such as those mentioned
in §D above does not of itself indicate the severity of the condition. Where development
is indicated to verify diagnosis and/or severity the A/B MAC (B) should follow existing
claims processing practices, which may include review of A/B MAC (B)’s history and
medical consultation as well as physician contacts.

The rules in §290.F concerning presumption of coverage also apply.

Codes and policies for routine foot care and supportive devices for the feet are not
exclusively for the use of podiatrists. These codes must be used to report foot care
services regardless of the specialty of the physician who furnishes the services. A/B
MACs (B) must instruct physicians to use the most appropriate code available when
billing for routine foot care.

300 - Diabetes Self-Management Training Services
(Rev. 72, Issued: 05-25-07; Effective: 07-01-07; Implementation: 07-02-07)

Section 4105 of the Balanced Budget Act of 1997 permits Medicare coverage of diabetes
self-management training (DSMT) services when these services are furnished by a
certified provider who meets certain quality standards. This program is intended to
educate beneficiaries in the successful self-management of diabetes. The program
includes instructions in self-monitoring of blood glucose; education about diet and
exercise; an insulin treatment plan developed specifically for the patient who is insulin-
dependent; and motivation for patients to use the skills for self-management.