Medicare AdvantageBilling CodesMedium impact
MA11.014h, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Independence Blue Cross·PA · Podiatry, Dermatology, General Practice·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated ICD-10 diagnosis codes effective 10/01/2025 for policy MA11.014h covering nail debridement. One code (E11.A for Type 2 diabetes in remission) was added to qualifying systemic illness criteria, seven multiple sclerosis codes (G35.A, G35.B0-B2, G35.C0-C2, G35.D) replaced the single G35 code, and the generic G35 code was deleted. These changes align with updated CMS coding standards but do not modify coverage criteria or reimbursement.
Action Required
By October 1, 2025: Billing team must update diagnosis code validation tables in the billing system to recognize the seven new G35 multiple sclerosis subcategory codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D) and remove the generic G35 code for claims processing on MA11.014h nail debridement services. Add the new E11.A diabetes code to the qualifying systemic illness list in authorization protocols. Update claim submission templates and prior authorization forms to reflect these specific codes. Claims submitted with the deleted G35 code or using outdated code combinations may be denied or delayed. Providers should be notified of the coding changes to ensure accurate documentation on encounter forms.