Full Answer
Does Medicare cover 11720 and 11721 nail debridement?
Medicare will cover 11720 and/or 11721 mycotic nail debridement no more often than every 60 days. Medicare will cover no more than six 11720 and/or 11721 sessions per patient per 24 months absent medical review of patient records demonstrating medical necessity for the procedure.
How often can you get a 11720 debridement?
Utilization Guidelines Medicare will cover 11720 and/or 11721 mycotic nail debridement no more often than every 60 days. Medicare will cover no more than six 11720 and/or 11721 sessions per patient per 24 months absent medical review of patient records demonstrating medical necessity for the procedure.
Can nail debridement be routine foot care?
Nail Debridement Can't Be Routine Foot Care. The U.S. Department of Health and Human Services defines nail debridement as the "removal of a diseased toenail bed or viable nail plate.".
Does Medicare cover mycotic nail debridement?
As with other Medicare-covered services, mycotic nail debridement must be reasonable and necessary for the treatment of an illness or injury or to improve the functioning of a malformed body member. Medicare payment generally may be made for mycotic nail debridement in the two following circumstances:
How often does Medicare pay for nail debridement?
every 60 daysMedicare will cover debridement of nail(s) by any method(s); 1 to 5 and/or debridement of nail(s) by any method(s); 6 or more no more often than every 60 days.
How often does Medicare allow toenails to be cut?
once every 61 daysMedicare will cover the treatment of corns, calluses, and toenails once every 61 days in persons having certain systemic conditions.
How often can 11721 be billed?
Medicare will cover 11720 and/or 11721 mycotic nail debridement no more often than every 60 days. Medicare will cover no more than six 11720 and/or 11721 sessions per patient per 24 months absent medical review of patient records demonstrating medical necessity for the procedure.
How do you bill nail debridement?
When reporting debridement of mycotic nails (CPT codes 11720, 11721), the primary diagnosis representing the patient's dermatophytosis of the nail must be listed, as well as the secondary diagnosis representing the systemic condition.
Where do seniors get their toenails cut?
PodiatristVisit a Podiatrist Visiting a podiatrist regularly allows them to assess your overall foot health and share proper toenail trimming techniques. If you can't trim your own toenails, a podiatrist can do that during your visit.
Does Medicare cover toenail removal?
Medicare will cover treatments for treatment for an ingrown toenail as long as your doctor deems it medically necessary. A podiatrist will remove the section of your toenail that has become ingrown and is causing you pain.
What is the CPT code for debridement of 10 nails?
When reporting debridement of mycotic nails (CPT codes 11720, 11721), the primary diagnosis representing the patient's dermatophytosis of the nail must be listed, as well as the secondary diagnosis representing the systemic condition.
What is the difference between G0127 and 11721?
Procedure Code 11720 or 11721 are included in Medicare's covered foot care when billed with a diagnosis pertaining to debridement of nail. Refer to the Diagnosis Code List. Procedure Code G0127 is included in Medicare's covered foot care when billed with a diagnosis pertaining to dystrophic nails.
How often can 11055 be billed?
two-monthAccording to the Centers for Medicare & Medicaid Services (CMS), routine foot care is allowed one time within a two-month period. Therefore, the following CPT codes should only be billed once within a two-month time frame: 11055-11057 (Paring or cutting of benign hyperkeratotic lesion).
What is debridement toenails?
Nail debridement involves the removal of a diseased toenail bed or viable nail plate. This may be performed manually with an instrument, or with an electric grinder. Podiatrists generally provide nail debridement to patients diagnosed with onychomycosis (i.e., mycosis or mycotic toenails).
What is the CPT code for debridement?
For example, CPT code 11042 defined as “debridement, subcutaneous tissue” should be used if only necrotic subcutaneous tissue is debrided, even though the ulcer or wound might extend to the bone.
Does 11720 need a modifier?
A diagnosis of onychomycosis can allow 11720 or 11721 if it has either a Q modifier (but does not need a MD or DO last seen) or if it has one of the 6 ICD-9 codes listed in the special section for onychomycosis, i.e. difficulty with walking (681.10, 681.11, 703.0, 719.7, 729.5, 781.2).
How often does Medicare cover mycotic nail debridement?
Medicare will cover 11720 and/or 11721 mycotic nail debridement no more often than every 60 days. Medicare will cover no more than six 11720 and/or 11721 sessions per patient per 24 months absent medical review of patient records demonstrating medical necessity for the procedure.
Does Medicare cover mycotic nails?
Medicare will cover debridement of mycotic nails as an adjunct to pharmacologic treatment with a prescription antifungal agent indicated per its Food and Drug Administration (FDA) label for the treatment of fungal nail infections.
How to keep nail trimmers clean?
shower. • Keep all your trimming tools clean by washing or wiping them with rubbing alcohol. • Make sure your hands and feet are clean before and after trimming. • Cut your toenails straight across, do not cut into the curve around the end of the nail. • Avoid cutting the skin and do not cut calluses.
Why is it important to trim your toenails?
Why Proper Toenail Trimming is Important. If your toenails are not taken care of, they may cause injury by scratching or puncturing your skin, breaking off and exposing delicate skin under the nail, or by tearing off because of snagging on clothing or other materials .
Why is it so hard to cut your fingernails?
As people get older, paying attention to good health and hygiene becomes even more important. Simple routine tasks, like cutting your fingernails and toenails, can become difficult or even impossible if you have impaired vision or a problem with mobility.
Is it safe to go to a nail salon?
If you choose to visit a nail salon, be sure that it is a reputable one, your pedicurist is experienced, and that the equipment they use is sterilized. If you have diabetes or other health issues, it is safest to visit a podiatrist for your routine foot care.
Does Medicare cover nail trimming?
If you are covered by Original Medicare Part B (medical insurance) or have a Medicare Advantage (Part C) policy, you may have coverage for nail trimming and other types of foot care. While Medicare Part B insurance does not generally cover routine foot care services which may include toenail clipping or corn and callus removal, ...
How often does Medicare cover mycotic nail debridement?
Medicare will cover 11720 and/or 11721 mycotic nail debridement no more often than every 60 days. Medicare will cover no more than six 11720 and/or 11721 sessions per patient per 24 months absent medical review of patient records demonstrating medical necessity for the procedure. Medicare will not cover 11721 in the absence ...
Does Medicare cover 11721?
Medicare will not cover 11721 in the absence of a routine foot care exception qualifying condition absent medical review of patient records demonstrating medical necessity for the procedure. Notice: This LCD imposes utilization guideline limitations.
Does Medicare cover mycotic nails?
Medicare will cover debridement of mycotic nails as an adjunct to pharmacologic treatment with a prescription antifungal agent indicated per its Food and Drug Administration (FDA) label for the treatment of fungal nail infections.
Does Medicare require a detailed clinical description of mycotic nail debridement?
Medicare does not require the detailed clinical description to be repeated at each instance of mycotic nail debridement when an earlier record continues to accurately describe the patient’s condition at the time of the foot care.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Routine Foot Care and Debridement of Nails.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.