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Routine Foot Care for Health Partners (Medicaid) Adult Members

This is a notification regarding upcoming changes regarding coverage of routine foot care.

As a reminder, routine foot care is not a covered benefit for Health Partners (Medicaid) members. Effective April 1, 2019, routine foot care procedures will be covered only when the condition meets the criteria for medical necessity, as defined under ICD-10 per Medicare’s (Novitas) LCD Routine Foot Care (L35138).*

Routine Foot Care CPT and HCPCS codes include:

  • 11055 Trim skin lesion
  • 11056 Trim skin lesions 2 to 4
  • 11057 Trim skin lesions over 4
  • 11719 Trim nail(s) any number
  • 11720 Debride nail 1-5 11721 Debride nail 6 or more
  • G0127 Trim nail(s)

BACKGROUND

As a reminder, HPP covers foot care for Health Partners (Medicaid) adult members for medical and/or surgical treatment of conditions of the feet such as (but not limited to) bunions, ingrown toenails, plantar warts and hammertoes. Treatment of corns, calluses, nails of feet, flat feet, fallen arches, chronic foot strain and/or symptomatic complaints of the feet are not covered unless associated with disease affecting the lower limbs that requires the care of a podiatrist or a physician. The following metabolic, neurologic and peripheral vascular diseases most commonly represent the underlying conditions that warrants coverage for routine foot care (not all-inclusive):

  • Diabetes mellitus
  • Arteriosclerosis obliterans
  • Chronic venous insufficiency
  • Intractable edema-secondary to a specific disease (e.g., congestive heart failure, kidney disease, and hypothyroidism)
  • Peripheral vascular disease
  • Raynaud's disease

For more information about routine foot care coverage, please contact our Provider Services Helpline at 1-888-991-9023 (M–F, 9:00 a.m. to 5:30 p.m.).

* CMS website. Local Coverage Determination (LCD): Routine Foot Care (L35138)