A podiatrist, or foot doctor, diagnoses and treats conditions of the foot along with the ankle and related areas of the leg. Although Medicare reimburses podiatrists for a variety of foot-related procedures, nail debridement is one of the most common. However, Medicare will reimburse a podiatrist for nail debridement conducted on a patient only if the procedure is medically necessary and reasonable.
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." It can be done manually or with an electric grinder. Medicare will only cover nail debridement if it is medically necessary, which is when the patient has a systemic condition caused by a vascular or neurological disease that has resulted in diminished sensation or circulation, or has mycosis of the toenail with limited movement and pain or a secondary infection caused by one or more mycotic toenails. If the nail debridement is not done for one of these reasons, it is considered routine foot care, which is not covered by Medicare. If the nail debridement meets Medicare's medically necessary requirement, it will cover the service once every 60 days.
References
- American Podiatric Medical Association: What Is a Podiatrist?
- U.S. Department of Health and Human Services, Office of Inspector General: Medicare Payments for Nail Debridement Services
- AAPC: Present Convincing Evidence for Routine Foot Care Necessity
- Quick Notes: Podiatry – Medicare - Foot and Nail Care Services
- WPS Medicare: Foot Care Frequently Asked Questions (FAQs)
- Centers for Medicaid and Medicare Services: Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 290 - Foot Care
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