Medical policy: Foot Care Services

Número de política: MP 4.018

Beneficio clínico

  • Minimizar el riesgo o la preocupación de seguridad.
  • Minimizar las intervenciones dañinas o ineficaces.
  • Garantizar el nivel de atención adecuado.
  • Asegurar la duración adecuada del servicio para las intervenciones.
  • Asegurar que se hayan cumplido los requisitos médicos recomendados.
  • Asegurar el lugar apropiado para el tratamiento o servicio.

Fecha de entrada en vigor: 10/1/2026

Política

Routine foot care services may be considered medically necessary when there is:

  • Systemic disease (metabolic, neurologic, or peripheral vascular) that would put the patient at risk if provided by a nonprofessional person. Conditions that may result in the need for routine foot care include the following:
    • Amyotrophic Lateral Sclerosis (ALS)
    • Arteriosclerosis obliterans (A.S.O.), arteriosclerosis of the extremities, occlusive peripheral arteriosclerosis
    • Arteritis of the feet
    • Buerger’s disease
    • Chronic indurated cellulitis
    • Chronic venous insufficiency
    • Diabetes mellitus
    • Intractable edema
    • Lymphedema (moderate to severe; based on any grading system i.e., The National Cancer Institute Common Terminology for Adverse Events (CTCAE), The American Physical Therapy Association (APTA) or The International Society of Lymphology (ISL))
    • Peripheral neuropathies involving the feet (associated with, but not limited to, the following):
      • Associated with malnutrition and vitamin deficiency
        • Malnutrition (general, pellagra)
        • Alcoholism
        • Malabsorption (celiac disease, tropical sprue)
        • Pernicious anemia
      • Associated with carcinoma
      • Associated with diabetes mellitus
      • Associated with drugs and toxins (including, but not limited to, anticoagulants and immune modulating medications)
      • Associated with multiple sclerosis
      • Associated with uremia (chronic kidney disease [CKD])
      • Associated with traumatic injury
      • Associated with leprosy or neurosyphilis
      • Associated with hereditary disorders (including, but not limited to, the following):
        • Hereditary sensory radicular neuropathy
        • Angiokeratoma corporis diffusum (Fabry’s)
        • Amyloid neuropathy
      • Associated with Rheumatoid arthritis
    • Peripheral vascular disease
    • Raynaud’s phenomenon secondary to a concurrent connective tissue disease
    • Stricture of artery

Evaluation and debridement of mycotic nails may be considered medically necessary when the above criteria are met.

Evaluation and debridement of mycotic nails, in the absence of a systemic condition listed above, may be considered medically necessary when the following criteria are met.

  • The patient is diagnosed as having tinea unguium (onychomycoses or dermatophytoses)
    • Pain and/or secondary infection resulting from the thickening and dystrophy of the infected toenail plate
    • If ambulatory, marked limitation of ambulation (pain and/or abnormality of gait)

Variaciones del producto

Esta política solo se aplica a ciertos programas y productos administrados por Capital Blue Cross y está sujeta a variaciones en los beneficios. Consulte la información adicional a continuación.

FEP PPO - Refer to the FEP Medical Policy Manual. The FEP Medical Policy Manual can be found at: FEP Medical Policy Manual.

Descripción/Antecedentes

Foot care services include the examination, diagnosis and medical or surgical treatment of conditions and dysfunctions of the foot. Foot care services can be routine or non-routine. In most cases, routine foot care does not require the skills of a qualified provider of foot care services, i.e., a podiatrist or physician. However, there are clinical diagnoses such as poor circulation to the extremities and other conditions where the services of a professional foot care provider may be medically necessary in order to limit complications such as delayed healing or infection.

Fundamento

N/D

Definiciones

Mycotic refers to being caused by or infected with fungus.

Non-routine foot care would include surgical treatment of structural defects or anomalies such as fractures, hammer toes, or bunions. It also includes surgery for ingrown toenails. An injectable local anesthetic must be used in order for a foot procedure to be considered "toenail surgery."

Keratoma (also known as a callus) are hard, light-colored patches of skin that develop as a result of friction or pressure.

Tyloma is a localized overgrowth of skin due to pressure or friction.

Routine foot care involves, but is not limited to, hygiene and maintenance care (e.g., cleaning and soaking of feet, use of skin creams to maintain skin tone), trimming of nails (except surgery for ingrown nails), treatment of corns, calluses, keratoses, nonsurgical treatment of bunions, and treatment and debridement of mycotic nails.

Exención de responsabilidad

Las políticas médicas de Capital Blue Cross se utilizan para determinar la cobertura de tecnologías, procedimientos, equipos y servicios médicos específicos. Estas políticas médicas no constituyen un consejo médico y están sujetas a cambios según lo permita la ley o la evidencia clínica aplicable de las pautas de tratamiento independientes. Los proveedores que brindan tratamiento son individualmente responsables de los consejos médicos y el tratamiento de los miembros. Estas políticas no son una garantía de cobertura o pago. El pago de las reclamaciones está sujeto a la determinación del programa de beneficios del miembro y la elegibilidad en la fecha del servicio, y a la determinación de que los servicios son médicamente necesarios y apropiados. El procesamiento final de una reclamación se basa en los términos del contrato que se aplican al programa de beneficios de los miembros, incluidas las limitaciones y exclusiones de beneficios. Si un proveedor o miembro tiene alguna pregunta sobre esta política médica, debe comunicarse con Servicios para proveedores o Servicios para miembros de Capital Blue Cross.

Información de codificación

Nota: esta lista de códigos puede no ser exhaustiva y los códigos están sujetos a cambios en cualquier momento. La identificación de un código en esta sección no denota cobertura, ya que la cobertura está determinada por los términos de la información de beneficios del miembro. Además, no todos los servicios cubiertos son elegibles para un reembolso por separado.

Cubierto cuando es médicamente necesario

Códigos de procedimiento

11055

11056

11057

11719

11720

11721

G0127

G0247

S0390

 
Códigos de diagnóstico de la CIE-10-MC
Descripción

A30.0

Indeterminate leprosy

A30.1

Tuberculoid leprosy

A30.2

Borderline tuberculoid leprosy

A30.3

Borderline leprosy

A30.4

Borderline lepromatous leprosy

A30.5

Lepromatous leprosy

A30.8

Other forms of leprosy

A30.9

Leprosy, unspecified

A50.40

Late congenital neurosyphilis, unspecified

A50.43

Late congenital syphilitic polyneuropathy

A50.45

Juvenile general paresis

A52.15

Late syphilitic neuropathy

A52.16

Charcot's arthropathy (tabetic)

A52.17

General paresis

A52.19

Other symptomatic neurosyphilis

A52.2

Asymptomatic neurosyphilis

D09.8

Carcinoma in situ of other specified sites

D09.9

Carcinoma in situ, unspecified

D51.0

Vitamin B12 deficiency anemia due to intrinsic factor deficiency

E08.00

Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

E08.10

Diabetes mellitus due to underlying condition with ketoacidosis without coma

E08.21

Diabetes mellitus due to underlying condition with diabetic nephropathy

E08.22

Diabetes mellitus due to underlying condition with diabetic chronic kidney disease

E08.29

Diabetes mellitus due to underlying condition with other diabetic kidney complication

E08.40

Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified

E08.41

Diabetes mellitus due to underlying condition with diabetic mononeuropathy

E08.42

Diabetes mellitus due to underlying condition with diabetic polyneuropathy

E08.43

Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy

E08.44

Diabetes mellitus due to underlying condition with diabetic amyotrophy

E08.49

Diabetes mellitus due to underlying condition with other diabetic neurological complication

E08.51

Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene

E08.52

Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene

E08.59

Diabetes mellitus due to underlying condition with other circulatory complications

E08.610

Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy

E08.618

Diabetes mellitus due to underlying condition with other diabetic arthropathy

E08.620

Diabetes mellitus due to underlying condition with diabetic dermatitis

E08.621

Diabetes mellitus due to underlying condition with foot ulcer

E08.622

Diabetes mellitus due to underlying condition with other skin ulcer

E08.628

Diabetes mellitus due to underlying condition with other skin complications

E08.65

Diabetes mellitus due to underlying condition with hyperglycemia

E08.69

Diabetes mellitus due to underlying condition with other specified complication

E08.8

Diabetes mellitus due to underlying condition with unspecified complications

E08.9

Diabetes mellitus due to underlying condition without complications

E09.00

Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

E09.10

Drug or chemical induced diabetes mellitus with ketoacidosis without coma

E09.21

Drug or chemical induced diabetes mellitus with diabetic nephropathy

E09.22

Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease

E09.29

Drug or chemical induced diabetes mellitus with other diabetic kidney complication

E09.40

Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified

E09.41

Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy

E09.42

Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy

E09.43

Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy

E09.44

Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy

E09.49

Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication

E09.51

Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene

E09.52

Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene

E09.59

Drug or chemical induced diabetes mellitus with other circulatory complications

E09.610

Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy

E09.618

Drug or chemical induced diabetes mellitus with other diabetic arthropathy

E09.620

Drug or chemical induced diabetes mellitus with diabetic dermatitis

E09.621

Drug or chemical induced diabetes mellitus with foot ulcer

E09.622

Drug or chemical induced diabetes mellitus with other skin ulcer

E09.628

Drug or chemical induced diabetes mellitus with other skin complications

E09.649

Drug or chemical induced diabetes mellitus with hypoglycemia without coma

E09.65

Drug or chemical induced diabetes mellitus with hyperglycemia

E09.69

Drug or chemical induced diabetes mellitus with other specified complication

E09.8

Drug or chemical induced diabetes mellitus with unspecified complications

E09.9

Drug or chemical induced diabetes mellitus without complications

E10.A0

Type 1 diabetes mellitus, presymptomatic, unspecified

E10.A1

Type 1 diabetes mellitus, presymptomatic, Stage 1

E10.A2

Type 1 diabetes mellitus, presymptomatic, Stage 2

E10.10

Type 1 diabetes mellitus with ketoacidosis without coma

E10.21

Type 1 diabetes mellitus with diabetic nephropathy

E10.22

Type 1 diabetes mellitus with diabetic chronic kidney disease

E10.29

Type 1 diabetes mellitus with other diabetic kidney complication

E10.40

Type 1 diabetes mellitus with diabetic neuropathy, unspecified

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

E10.59

Type 1 diabetes mellitus with other circulatory complications

E10.610

Type 1 diabetes mellitus with diabetic neuropathic arthropathy

E10.618

Type 1 diabetes mellitus with other diabetic arthropathy

E10.620

Type 1 diabetes mellitus with diabetic dermatitis

E10.621

Type 1 diabetes mellitus with foot ulcer

E10.622

Type 1 diabetes mellitus with other skin ulcer

E10.628

Type 1 diabetes mellitus with other skin complications

E10.649

Type 1 diabetes mellitus with hypoglycemia without coma

E10.65

Type 1 diabetes mellitus with hyperglycemia

E10.69

Type 1 diabetes mellitus with other specified complication

E10.8

Type 1 diabetes mellitus with unspecified complications

E10.9

Type 1 diabetes mellitus without complications

E11.00

Type 2 diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

E11.10

Type 2 diabetes mellitus with ketoacidosis without coma

E11.21

Type 2 diabetes mellitus with diabetic nephropathy

E11.22

Type 2 diabetes mellitus with diabetic chronic kidney disease

E11.29

Type 2 diabetes mellitus with other diabetic kidney complication

E11.40

Type 2 diabetes mellitus with diabetic neuropathy, unspecified

E11.41

Type 2 diabetes mellitus with diabetic mononeuropathy

E11.42

Type 2 diabetes mellitus with diabetic polyneuropathy

E11.43

Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

E11.44

Type 2 diabetes mellitus with diabetic amyotrophy

E11.49

Type 2 diabetes mellitus with other diabetic neurological complication

E11.51

Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene

E11.52

Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene

E11.59

Type 2 diabetes mellitus with other circulatory complications

E11.610

Type 2 diabetes mellitus with diabetic neuropathic arthropathy

E11.618

Type 2 diabetes mellitus with other diabetic arthropathy

E11.620

Type 2 diabetes mellitus with diabetic dermatitis

E11.621

Type 2 diabetes mellitus with foot ulcer

E11.622

Type 2 diabetes mellitus with other skin ulcer

E11.628

Type 2 diabetes mellitus with other skin complications

E11.649

Type 2 diabetes mellitus with hypoglycemia without coma

E11.65

Type 2 diabetes mellitus with hyperglycemia

E11.69

Type 2 diabetes mellitus with other specified complication

E11.8

Type 2 diabetes mellitus with unspecified complications

E11.9

Type 2 diabetes mellitus without complications

E11.A

Type 2 diabetes mellitus without complications in remission

E13.00

Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC)

E13.10

Other specified diabetes mellitus with ketoacidosis without coma

E13.21

Other specified diabetes mellitus with diabetic nephropathy

E13.22

Other specified diabetes mellitus with diabetic chronic kidney disease

E13.29

Other specified diabetes mellitus with other diabetic kidney complication

E13.40

Other specified diabetes mellitus with diabetic neuropathy, unspecified

E13.41

Other specified diabetes mellitus with diabetic mononeuropathy

E13.42

Other specified diabetes mellitus with diabetic polyneuropathy

E13.43

Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy

E13.44

Other specified diabetes mellitus with diabetic amyotrophy

E13.49

Other specified diabetes mellitus with other diabetic neurological complication

E13.51

Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene

E13.52

Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene

E13.59

Other specified diabetes mellitus with other circulatory complications

E13.610

Other specified diabetes mellitus with diabetic neuropathic arthropathy

E13.618

Other specified diabetes mellitus with other diabetic arthropathy

E13.620

Other specified diabetes mellitus with diabetic dermatitis

E13.621

Other specified diabetes mellitus with foot ulcer

E13.622

Other specified diabetes mellitus with other skin ulcer

E13.628

Other specified diabetes mellitus with other skin complications

E13.649

Other specified diabetes mellitus with hypoglycemia without coma

E13.65

Other specified diabetes mellitus with hyperglycemia

E13.69

Other specified diabetes mellitus with other specified complication

E13.8

Other specified diabetes mellitus with unspecified complications

E13.9

Other specified diabetes mellitus without complications

E52

Niacin deficiency [pellagra]

E53.0

Riboflavin deficiency

E53.1

Pyridoxine deficiency

E53.8

Deficiency of other specified B group vitamins

E75.21

Fabry (-Anderson) disease

E85.1

Neuropathic heredofamilial amyloidosis

G12.21

Amyotrophic lateral sclerosis

G13.0

Paraneoplastic neuromyopathy and neuropathy

G35

Multiple sclerosis

G35.A

Relapsing-remitting multiple sclerosis

G35.B

Primary progressive multiple sclerosis

G35.B0

Primary progressive multiple sclerosis, unspecified

G35.B1

Active primary progressive multiple sclerosis

G35.B2

Non-active primary progressive multiple sclerosis

G35.C

Secondary progressive multiple sclerosis

G35.C0

Secondary progressive multiple sclerosis, unspecified

G35.C1

Active secondary progressive multiple sclerosis

G35.C2

Non-active secondary progressive multiple sclerosis

G35.D

Multiple sclerosis, unspecified

G60.0

Hereditary motor and sensory neuropathy

G60.2

Neuropathy in association with hereditary ataxia

G60.3

Idiopathic progressive neuropathy

G60.8

Other hereditary and idiopathic neuropathies

G60.9

Hereditary and idiopathic neuropathy, unspecified

G61.0

Guillain-Barre syndrome

G61.1

Serum neuropathy

G61.81

Chronic inflammatory demyelinating polyneuritis

G61.89

Other inflammatory polyneuropathies

G62.0

Drug-induced polyneuropathy

G62.1

Alcoholic polyneuropathy

G62.2

Polyneuropathy due to other toxic agents

G62.81

Critical illness polyneuropathy

G62.82

Radiation-induced polyneuropathy

G62.89

Other specified polyneuropathies

G62.9

Polyneuropathy, unspecified

G63

Polyneuropathy in diseases classified elsewhere

G64

Other disorders of peripheral nervous system

G65.0

Sequelae of Guillain-Barre syndrome

G65.1

Sequelae of other inflammatory polyneuropathy

G65.2

Sequelae of toxic polyneuropathy

G90.09

Other idiopathic peripheral autonomic neuropathy

G99.0

Autonomic neuropathy in diseases classified elsewhere

I70.201

Unspecified atherosclerosis of native arteries of extremities, right leg

I70.202

Unspecified atherosclerosis of native arteries of extremities, left leg

I70.203

Unspecified atherosclerosis of native arteries of extremities, bilateral legs

I70.208

Unspecified atherosclerosis of native arteries of extremities, other extremity

I70.209

Unspecified atherosclerosis of native arteries of extremities, unspecified extremity

I70.211

Atherosclerosis of native arteries of extremities with intermittent claudication, right leg

I70.212

Atherosclerosis of native arteries of extremities with intermittent claudication, left leg

I70.213

Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs

I70.218

Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity

I70.219

Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity

I70.221

Atherosclerosis of native arteries of extremities with rest pain, right leg

I70.222

Atherosclerosis of native arteries of extremities with rest pain, left leg

I70.223

Atherosclerosis of native arteries of extremities with rest pain, bilateral legs

I70.228

Atherosclerosis of native arteries of extremities with rest pain, other extremity

I70.229

Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity

I70.231

Atherosclerosis of native arteries of right leg with ulceration of thigh

I70.232

Atherosclerosis of native arteries of right leg with ulceration of calf

I70.233

Atherosclerosis of native arteries of right leg with ulceration of ankle

I70.234

Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot

I70.235

Atherosclerosis of native arteries of right leg with ulceration of other part of foot

I70.238

Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg

I70.239

Atherosclerosis of native arteries of right leg with ulceration of unspecified site

I70.241

Atherosclerosis of native arteries of left leg with ulceration of thigh

I70.242

Atherosclerosis of native arteries of left leg with ulceration of calf

I70.243

Atherosclerosis of native arteries of left leg with ulceration of ankle

I70.244

Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot

I70.245

Atherosclerosis of native arteries of left leg with ulceration of other part of foot

I70.248

Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg

I70.249

Atherosclerosis of native arteries of left leg with ulceration of unspecified site

I70.261

Atherosclerosis of native arteries of extremities with gangrene, right leg

I70.262

Atherosclerosis of native arteries of extremities with gangrene, left leg

I70.263

Atherosclerosis of native arteries of extremities with gangrene, bilateral legs

I70.269

Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity

I70.291

Other atherosclerosis of native arteries of extremities, right leg

I70.292

Other atherosclerosis of native arteries of extremities, left leg

I70.293

Other atherosclerosis of native arteries of extremities, bilateral legs

I70.299

Other atherosclerosis of native arteries of extremities, unspecified extremity

I70.90

Unspecified atherosclerosis

I70.91

Generalized atherosclerosis

I73.00

Raynaud's syndrome without gangrene

I73.01

Raynaud's syndrome with gangrene

I73.1

Thromboangiitis obliterans [Buerger's disease]

I73.81

Erythromelalgia

I73.89

Other specified peripheral vascular diseases

I73.9

Peripheral vascular disease, unspecified

I77.1

Stricture of artery

I77.6

Arteritis, unspecified

I79.1

Aortitis in diseases classified elsewhere

I79.8

Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere

I87.1

Compression of vein

I87.2

Venous insufficiency (chronic) (peripheral)

I87.301

Chronic venous hypertension (idiopathic) without complications of right lower extremity

I87.302

Chronic venous hypertension (idiopathic) without complications of left lower extremity

I87.303

Chronic venous hypertension (idiopathic) without complications of bilateral lower extremity

I87.311

Chronic venous hypertension (idiopathic) with ulcer of right lower extremity

I87.312

Chronic venous hypertension (idiopathic) with ulcer of left lower extremity

I87.313

Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity

I87.321

Chronic venous hypertension (idiopathic) with inflammation of right lower extremity

I87.322

Chronic venous hypertension (idiopathic) with inflammation of left lower extremity

I87.323

Chronic venous hypertension (idiopathic) with inflammation of bilateral lower extremity

I87.329

Chronic venous hypertension (idiopathic) with inflammation of unspecified lower extremity

I87.331

Chronic venous hypertension (idiopathic) with ulcer and inflammation of right lower extremity

I87.332

Chronic venous hypertension (idiopathic) with ulcer and inflammation of left lower extremity

I87.333

Chronic venous hypertension (idiopathic) with ulcer and inflammation of bilateral lower extremity

I87.339

Chronic venous hypertension (idiopathic) with ulcer and inflammation of unspecified lower extremity

I87.391

Chronic venous hypertension (idiopathic) with other complications of right lower extremity

I87.392

Chronic venous hypertension (idiopathic) with other complications of left lower extremity

I87.393

Chronic venous hypertension (idiopathic) with other complications of bilateral lower extremity

I87.399

Chronic venous hypertension (idiopathic) with other complications of unspecified lower extremity

I87.8

Other specified disorders of veins

I89.0

Linfedema, no clasificado en otra parte.

I99.8

Other disorder of circulatory system

K90.0

Celiac disease

K90.1

Tropical sprue

K90.9

Intestinal malabsorption, unspecified

L02.415

Cutaneous abscess of right lower limb

L02.416

Cutaneous abscess of left lower limb

L02.611

Cutaneous abscess of right foot

L02.612

Cutaneous abscess of left foot

L02.619

Cutaneous abscess of unspecified foot

L03.031

Cellulitis of right toe

L03.032

Cellulitis of left toe

L03.039

Cellulitis of unspecified toe

L03.115

Cellulitis of right lower limb

L03.116

Cellulitis of left lower limb

L03.125

Acute lymphangitis of right lower limb

L03.126

Acute lymphangitis of left lower limb

L03.41

Acute lymphangitis of right toe

L03.42

Acute lymphangitis of left toe

L98.3

Eosinophilic cellulitis [Wells]

M05.50

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified site

M05.511

Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder

M05.512

Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder

M05.519

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified shoulder

M05.521

Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow

M05.522

Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow

M05.529

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified elbow

M05.531

Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist

M05.532

Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist

M05.539

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified wrist

M05.541

Rheumatoid polyneuropathy with rheumatoid arthritis of right hand

M05.542

Rheumatoid polyneuropathy with rheumatoid arthritis of left hand

M05.549

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hand

M05.551

Rheumatoid polyneuropathy with rheumatoid arthritis of right hip

M05.552

Rheumatoid polyneuropathy with rheumatoid arthritis of left hip

M05.559

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified hip

M05.561

Rheumatoid polyneuropathy with rheumatoid arthritis of right knee

M05.562

Rheumatoid polyneuropathy with rheumatoid arthritis of left knee

M05.569

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified knee

M05.571

Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot

M05.572

Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot

M05.579

Rheumatoid polyneuropathy with rheumatoid arthritis of unspecified ankle and foot

M05.59

Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites

M34.83

Systemic sclerosis with polyneuropathy

N18.1

Chronic kidney disease, stage 1

N18.2

Chronic kidney disease, stage 2 (mild)

N18.30

Chronic kidney disease, stage 3 unspecified

N18.31

Chronic kidney disease, stage 3a

N18.32

Chronic kidney disease, stage 3b

N18.4

Chronic kidney disease, stage 4 (severe)

N18.5

Chronic kidney disease, stage 5

N18.6

End stage renal disease

N18.9

Chronic kidney disease, unspecified

Q82.0

Hereditary lymphedema

R23.4

Changes in skin texture (Induration of skin; scaling of skin)

R60.0

Localized edema

R60.1

Generalized edema

R60.9

Edema, unspecified

Z86.31

Personal history of diabetic foot ulcer

Z86.79

Personal history of other diseases of the circulatory system

Cubierto cuando es médicamente necesario

Códigos de procedimiento

11720

11721

G0127

G0247

S0390
Códigos de diagnóstico de la CIE-10-MC
Descripción

B35.1

Tinea unguium

Referencias

  1. Services National Coverage Determination (NCD), 70.2.1. Services provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy). Effective 7/1/2002. CMS.
  2. Taber’s Cyclopedic Medical Dictionary, 19th edition.
  3. PA State Board of Podiatry Act. P.L. 1199, No. 505.
  4. Bending A. Fungal nail infections: Far more than an aesthetic problem. Br J Community Nurs. 2002; 7(5):254-259. PMID: 12048499.
  5. Schaper NC, van Netten JJ, et al. Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev. 2020; 36(S1):e3266.
  6. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes-2020 (ADA). Diabetes Care. January 2020; 43(Supplement 1): S135-S151.
  7. Wexler DJ. Foot evaluation in people with diabetes mellitus. In: UpToDate Online Journal [serial online]. Waltham, MA: UpToDate; updated Dec. 19, 2025. Literature review current through April 2026.
  8. Local Coverage Determination (LCD), L35138. Routine Foot Care. Effective 10/17/2019. CMS.
  9. Medicare Benefit Policy Manual. Chapter 15-Covered Medical and Other Health Services. Issued: 05/08/2026, Rev. 13774. CMS.
  10. Lacouture ME, Kopsky DJ, Lilker R, et al. Podiatric Adverse Events and Foot Care in Cancer Patients and Survivors Awareness, Education, and Literature Review. J Am Podiatr Med Assoc. 2018;108(6):508-516. PMID: 30742505.
  11. Senneville É, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2024;40(3):e3687. PMID: 37779323.
  12. American Diabetes Association; Professional Practice Committee. Standards of Medical Care in Diabetes-2026. Diabetes Care. 1 January 2026; 49(Supplement_1).
  13. Pop-Busui R, Boulton AJM, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 1 January 2017; 40(1):136-154.

Antecedentes de la política

MP 2.018

09/21/2022 Consensus review. Coding reviewed. ICD codes updated (added A30.9, A52.19, E09.8, I87.329, I87.339, I87.399, N18.30, N18.31, N18.32). References updated.

05/30/2023 Consensus review. References updated. Coding reviewed. Deleted S99.821A and S99.822A. Added E11.10 and E11.649.

06/14/2024 Consensus review. No change to policy stance. New references.

05/07/2025 Consensus review. No change to policy stance. Added ICD-10 codes E10.A0-E10.A2.

Actualización administrativa del 09/02/2025. New ICD codes added effective 10/01/2025.

05/29/2026 Consensus review. No change to policy stance. References and ICD-10 table updated. Added ICD-10 code G62.82. Clarification: ICD-10 code B35.1 is for procedure codes 11720, 11721, G0127, G0247, and S0390.