Summary & Overview

HCPCS G0245: Initial Diabetic Foot Evaluation for Loss of Protective Sensation

HCPCS Level II code G0245 covers an initial physician evaluation and management visit specifically for diabetic patients with sensory neuropathy that has produced a loss of protective sensation (LOPS). This targeted assessment mandates documentation of LOPS, a focused history, a comprehensive foot examination addressing inspection, protective sensation testing, biomechanical and vascular assessment, skin integrity review, footwear recommendations, and patient education. The code supports early identification of foot risk factors that can prevent ulceration and amputation, making it clinically and operationally important for diabetes care management nationwide.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national perspective on clinical context and billing relevance for G0245, including typical sites of service, common documentation expectations, and how payers approach coverage for focused diabetic foot evaluations. The publication also outlines benchmarking and policy context where available and highlights areas where payers commonly require clear documentation to support medical necessity. This resource is intended to help coding, billing, and clinical teams understand what the code represents, what elements are essential in the visit, and what to expect from major payers when submitting claims for this specific diabetic foot evaluation service.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0245HCPCS Level IIdiabetic neuropathyloss of protective sensationdiabetic foot examevaluation and managementoutpatientfoot care

Billing Code Overview

HCPCS Level II code G0245 describes an initial physician evaluation and management service for a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS). The service must include: (1) the diagnosis of LOPS, (2) a patient history, (3) a physical examination that includes visual inspection of the forefoot, hindfoot and toe web spaces; evaluation of a protective sensation; evaluation of foot structure and biomechanics; evaluation of vascular status and skin integrity; and evaluation and recommendation of footwear, and (4) patient education.

Service type: Initial physician evaluation and management for diabetic sensory neuropathy with LOPS
Typical site of service: Outpatient clinic or office-based setting focused on diabetes foot care and evaluation

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with type 2 diabetes mellitus presents to a podiatry clinic for an initial comprehensive evaluation after the primary care provider documented numbness in both feet and a prior episode of plantar ulceration on the left forefoot. The visit is scheduled as an initial physician evaluation focused on confirming loss of protective sensation (LOPS) and completing a detailed foot risk assessment to guide footwear and preventive care.

During the clinical workflow the provider obtains a focused diabetic foot history (duration of diabetes, glycemic control, prior ulcers, neuropathic symptoms, prior foot surgeries, smoking status), performs a targeted physical examination and document the required elements: visual inspection of forefoot, hindfoot and toe web spaces for deformity, callus, breakdown or infection; assessment of protective sensation using a 10-g monofilament or equivalent test; evaluation of foot structure and biomechanics including deformities (hammer toe, Charcot foot, high arch, flatfoot); vascular assessment including palpation of dorsalis pedis and posterior tibial pulses and ankle-brachial index when indicated; inspection of skin integrity including callus, ulceration, erythema, or drainage; and evaluation and recommendation of footwear or offloading devices. The provider also delivers documented patient education on foot care, footwear selection, daily inspection, and when to seek urgent care.

Typical site of service is an outpatient clinic or ambulatory surgical center podiatry/physician clinic. The service type is an initial diabetic foot evaluation for neuropathy and loss of protective sensation coded to G0245. The encounter may result in immediate interventions (callus debridement billed separately if performed), referral to vascular surgery or orthotics ordering, and documentation that supports medical necessity for therapeutic footwear programs.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service	Use when a distinct E/M evaluation (documentation supports history, exam, and medical decision-making) is performed in addition to a procedure on the same date.
`22`	Increased procedural services	Use when the complexity or time of the evaluation is substantially greater than typical and additional documentation supports increased work.
`52`	Reduced services	Use when the service is partially reduced or not completed.
`53`	Discontinued procedure	Use when the evaluation or procedure is started but discontinued due to patient-related or clinical reasons.
`59`	Distinct procedural service (Note: Not in raw modifiers list)	Data not available in the input.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons for a complex surgical component arising from the evaluation and both are documented.
`78`	Unplanned return to the operating/procedure room for a related procedure during the postoperative period	Use if patient requires an unplanned procedural intervention related to findings from this evaluation.
`80`	Assistant surgeon	Use when an assistant surgeon performs part of a surgical procedure that resulted from the evaluation.
`82`	Assistant surgeon (when a qualified resident is not available)	Use when a qualified assistant is necessary and no resident is available.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice clinician functions as an assistant at surgery related to this evaluation.
`QK`	Medical direction of two, three, or four qualified health care professionals by a physician/PA (services involving CRNAs)	Use when the evaluation leads to anesthesia-related services that require medical direction.
`QX`	CRNA service with medical direction by a physician	Use when anesthesia services are billed with CRNA under medical direction.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when anesthesiologist directs one CRNA for a procedure related to this visit.
`23`	Unusual anesthesia	Use if anesthesia provided was unusual and not anticipated for the evaluation-related procedure.

Taxonomy Code	Specialty	Notes
`173D00000X`	Podiatry	Podiatrists commonly perform diabetic foot evaluations and LOPS assessments.
`207P00000X`	Family Medicine	Primary care physicians often perform initial diabetic foot screenings and refer as needed.
`207Q00000X`	Internal Medicine	Internists provide diabetic management and neuropathy screening in outpatient settings.
`2080P0216X`	Vascular Surgery	Vascular surgeons evaluate and manage vascular insufficiency identified during the exam.
`363L00000X`	Physical Medicine & Rehabilitation	PM&R providers may assess biomechanics and recommend orthotics or offloading devices.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.40`	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	Common underlying diagnosis for patients with sensory neuropathy and LOPS requiring this evaluation.
`E11.42`	Type 2 diabetes mellitus with diabetic polyneuropathy	Indicates generalized diabetic neuropathy; relevant when LOPS is documented.
`E10.40`	Type 1 diabetes mellitus with diabetic neuropathy, unspecified	Type 1 diabetes patients can develop neuropathy and require LOPS assessment.
`G62.9`	Polyneuropathy, unspecified	Non-diabetic polyneuropathy that may cause sensory loss requiring evaluation.
`L97.909`	Non-pressure chronic ulcer of unspecified part of lower leg, unspecified severity	Active or prior ulceration is a key risk factor prompting comprehensive diabetic foot evaluation.
`I70.213`	Atherosclerosis of native arteries of extremities with intermittent claudication, left leg	Peripheral arterial disease impacts vascular assessment and footwear/offloading recommendations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`11055`	Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); 1st lesion	Callus debridement commonly performed in the same visit for patients with callus contributing to ulceration risk; billed separately when performed.
`11719`	Trimming of nondystrophic nails, any number	Basic nail care that may be performed during the evaluation visit; billed separately.
`29580`	Application, cast; walking boot, removable	Provision or fitting of offloading or temporary immobilization devices following evaluation findings; billed when provided.
`29405`	Application, prefabricated foot orthosis	Prefabricated orthotic fitting often recommended after footwear assessment; may be billed when supplied.
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity	An alternative E/M code that may be used when payer policy does not accept `G0245` or when full E/M documentation supports this level of service.