Corporate

July 19, 2012 - Revised 02.22.13

Podiatry Services and Evaluation & Management Codes

This article is a reminder to Podiatrists regarding coverage guidelines for foot care and podiatric services.

  • Evaluation & Management (E/M) services provided on a repetitive basis to assess a patient's possible need for foot care are considered routine screening exams and are not covered. There must be an underlying systemic condition and/or signs and symptoms warranting the need for an E/M service.
  • E/M services provided on the same date of service as covered foot care are considered integral to the foot care and are not separately payable unless the service is separately identifiable from the foot care (noted by submitting CPT modifier 25 with the E/M service) and medically necessary. Maintain supporting documentation for the use of CPT modifier 25 in the patient's medical records.
  • Trimming of mycotic nails for a non-ambulatory patient is only covered if there is a secondary infection and/or the patient is experiencing pain caused by the dystrophic nail.
  • All physician services provided in conjunction with the covered debridement/wound or foot care CPT codes are paid under the fee schedule amount for the debridement/foot care/wound care CPT Codes

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