Routine Foot Care (CPB 0046, reviewed 2026-04-07)

By 2026-04-07: Billing team must implement the following protocol: (1) For ALL routine foot care claims (CPT 11055, 11056, 11057, 11730, 11732, 11750, 11765, 17110, 17111, 11719, 11720, 11721, G0127, S0390), verify the patient's specific Aetna plan benefit description to confirm routine foot care is NOT excluded. (2) If routine foot care is excluded in the plan, claims are ONLY billable if one of these conditions is met: (a) non-professional performance would be hazardous due to underlying condition/disease, (b) foot care is necessary and integral part of another covered service, or (c) debridement of mycotic nails with secondary infection/pain causing marked limitation of ambulation. (3) Require providers to document the medical necessity justification and underlying condition (diabetes, peripheral neuropathy, arteriosclerosis, chronic thrombophlebitis, etc.) on the claim or in the patient record before submitting. (4) Do NOT bill routine nail trimming (pedicure services) without documented disease of nails. (5) For diabetic patients with loss of protective sensation (LOPS), preferentially use G0245 (initial eval), G0246 (follow-up eval), or G0247 (routine care) codes with required documentation. Update billing software to flag routine foot care claims for manual review to verify medical necessity criteria are met. Train front-desk and billing staff to ask providers about systemic conditions before scheduling foot care procedures. Failure to verify plan coverage and medical necessity will result in claim denials.