Foot Care Services
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Defines medical necessity and coding guidance for routine foot care (corns, calluses, nail trimming/debridement, plantar wart paring, preventive foot maintenance) for Blue Cross Blue Shield of Kansas members and providers.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medical necessity for routine foot care
Covered when ANY of the following are met:
Supported by policy statement A
Supported by policy statement B
Supported by policy statement C
Not medically necessary
Policy statement D
The inclusion or exclusion of procedure, diagnosis, or device codes in this policy is provided for informational purposes only and does not constitute or imply member coverage or provider reimbursement. Providers must refer to the member's contract benefits in effect at the time of service to determine whether a given service is covered for an individual member.
Routine foot care furnished when the conditions or hazards described in the policy are not present is not medically necessary. When systemic conditions or situations that would make nonprofessional performance hazardous are absent, routine hygienic or preventive foot services may be denied.
Coding
| 11055 | Paring or cutting of benign hyperkeratotic lesion; single lesion |
| 11056 | Paring or cutting of benign hyperkeratotic lesion; 2 to 4 lesions |
| 11057 | Paring or cutting of benign hyperkeratotic lesion; more than 4 lesions |
| 11719 | Trimming of nondystrophic nails, any number |
| 11720 | Debridement of nail(s) by any method(s); 1 to 5 |
| 11721 | Debridement of nail(s) by any method(s); 6 or more |
| G0127 | Trimming of dystrophic nails, any number |
| G0247 | Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS); includes local care of superficial wounds, debridement of corns and calluses, and trimming/debridement of nails |
| S0390 | Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions, per visit |
| A52.15 | Late syphilitic neuropathy |
| E08.42 | Diabetes mellitus due to underlying condition with diabetic polyneuropathy |
| E09.42 | Drug or chemical induced diabetes mellitus with diabetic polyneuropathy |
| E10.41 | Type 1 diabetes mellitus with diabetic mononeuropathy |
| E10.42 | Type 1 diabetes mellitus with diabetic polyneuropathy |
| E10.43 | Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy |
| E10.44 | Type 1 diabetes mellitus with diabetic amyotrophy |
| E10.49 | Type 1 diabetes mellitus with other diabetic neurological complication |
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E10.52 | Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene |
Provider Actions & Billing
Predetermination / Benefit Verification
Submit a predetermination request when coverage is uncertain or when you need confirmation of member benefits prior to providing services. Predetermination helps determine coverage for foot care services and may prevent claim denials.
- Contact Blue Cross and Blue Shield of Kansas Customer Service for benefit verification.
- Submit predetermination requests through BCBSKS channels when coverage is unclear.
(Reserved)
Reserved — provider action callout.
Verification and Predetermination
Providers should verify member contract benefits at the time of service. When questions remain about coverage, submit a predetermination request or contact BCBSKS Customer Service or your professional/institutional relations representative for clarification.
- Verify member contract benefits in effect at the time of service.
- When coverage is uncertain, submit predetermination or contact BCBSKS customer service or professional relations.
Denial Risk for Routine/Non‑necessary Care
Routine foot care is considered not medically necessary in all other instances and may be denied when systemic conditions or hazards described in policy A–C are absent. Providers should document systemic conditions (metabolic, neurologic, peripheral vascular disease) or hazards that justify treatment.
- Routine foot care covered only when systemic conditions cause significant circulatory deficits or decreased sensation.
- Trimming/debridement of diseased, deformed or dystrophic nails and paring of benign hyperkeratotic lesions may be medically necessary when performance by a nonprofessional may pose a hazard.
Background
Routine foot care refers to non‑definitive hygienic and preventive maintenance services to the foot performed in the absence of localized illness, injury, or active symptoms. Examples include trimming normal or mycotic nails, paring or cutting benign hyperkeratotic lesions (corns or calluses), superficial wart paring (without curettage or chemical/thermal cautery), and general preventive maintenance. These services are considered medically necessary only when a systemic condition (metabolic, neurologic, or peripheral vascular disease) causes medically significant circulatory deficits or decreased sensation such that performance by a nonprofessional may pose a hazard, or when diseased, deformed, or dystrophic nails or hyperkeratotic lesions pose a similar hazard to nonprofessional care.
Definitions
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