Toenail care can help prevent pain and infection, and it can also be a way to provide comfort to a patient who is nearing the end of their life. Toenail care is an essential part of hospice care. Toe nails are a simple matter to cut, but some patients simply can’t care for their own nails. The Department of Public Health lists nail care as one of its approved functions for home health aides.
The federal government pays for medically necessary services and items in order for people to remain healthy. Foot care services such as nail cutting and trimming are not covered by Medicare, and can include corns and calluses removal.
It is not considered a Medicare service to cut toenails in a healthy person or to do so when they are not painful. It is not permissible for a podiatrist to try and obtain Medicare payment for non-covered foot care. Toenails grow by two millimeters per month, so your loved one may need to have a trim every six to eight weeks.
Ingrown toenail treatment costs less than $50 at home, but can cost up to $1,000 if you need a doctor’s visit. A podiatrist ensures that nails and calluses are properly trimmed. In addition to nail painting, foot massage, and foot massaging, only podiatrists provide ancillary services.
Even if you can take care of your toenails at home, you can consult with a podiatrist at Certified Foot and Ankle Specialists about trimming your toenails.
Medicare will cover the treatment of corns, calluses, and toenails once every 61 days in persons having certain systemic conditions. Examples of such conditions include: Diabetes with peripheral arterial disease, peripheral arterial disease, peripheral neuropathy, and chronic phlebitis.
The health condition also must be of sufficient severity to require professional care. The presence of uncomplicated diabetes or peripheral vascular disease may not qualify you for Medicare reimbursement for this care. You must also be under the active care of a physician for some of the above mentioned conditions. Medicare defines this as having seen your medical doctor within the last six months. Medicare requires your podiatrist to separate the charges for cutting of corns and calluses from the cutting of nails.
Ingrown Toenails
When a toenail penetrates the skin it can become painful and infected. If the treatment requires a partial removal of the nail under a local injectable anesthetic, Medicare should cover the service. If the treatment only requires a trimming of the nail corner, it is considered routine foot care and will not be a covered service.
Painful Thickened Nails
A fungal infection or toenail deformity may present as thickening and discoloration of toenails. If the toenails become painful or limit ambulation, and require reduction of the thickness and length, then this service may be covered by Medicare. If your podiatrist determines that this treatment might be covered, Medicare has rules regarding the frequency of this type of care.
Other Foot Conditions
Medicare generally covers the medical and surgical treatment of other foot conditions such as foot injuries, inflammatory disorders, infections, ulcerations, warts, bone deformities and other painful or symptomatic conditions of the foot.
If you have any questions concerning Medicare coverage please consult your podiatrist or contact Medicare at: 1-800-Medicare (800-633-4227).
Non-Covered Foot Care
The cutting of toenails in a healthy person or when they are not painful is not a payable service by Medicare.
The cutting of corns and calluses in a healthy person is not a payable service by Medicare. Legally, your podiatrist cannot try to obtain Medicare payment for noncovered foot care.
If you choose to have this service performed then you are responsible for payment directly to the treating podiatrist.
Waiver
If covered foot care is performed more frequently than Medicare allows, Medicare requires that you sign a waiver stating that you are aware that you have exceeded your allowed covered visits. You will be advised of this prior to treatment.
If you choose to have this service, you will be responsible for payment to your podiatrist for the foot care. If a claim is submitted for that non-covered service, your podiatrist is required to inform Medicare that non-covered services were performed.
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