Anthem Blue Cross Connecticut CG-MED-92 Foot Care Services Form

This document addresses the following foot care services: cutting or removal of corns or calluses, trimming, cutting, clipping or debriding of nails (including mycotic and ingrown toenails), and cleaning and soaking of the feet.

Note: Benefit language supersedes this document. Foot care services are not a covered benefit under all member contracts/certificates. Please see the text in the footnote of this document regarding Federal and State mandates and contract language, as these requirements or documents may specifically address the topic of foot care services.

Clinical Indications

Medically Necessary:

Foot care services including cutting or removal of corns or calluses, or trimming, cutting, clipping or debriding of nails are considered medically necessary when the following criteria are met:

1. The individual has a systemic condition resulting in circulatory insufficiency or desensitization of the lower extremity including, but not limited to, one or more of the conditions listed below:
   1. Arteriosclerosis; or
   2. Chronic thrombophlebitis; or
   3. Diabetes mellitus; or
   4. Peripheral vascular disease; or
   5. Peripheral neuropathy; or
   6. Raynaud’s disease; and
2. The individual is at risk of impeded healing that could potentially jeopardize life of limb, for example, evidence of sensory loss or prior ulceration or amputation, Charcot foot, history of angioplasty or vascular surgery, retinopathy, renal disease, or current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication); and
3. Performance of foot care services by a nonprofessional person would put the individual at risk; and
4. Foot care services are not provided more frequently than once every 2 months (unless documentation demonstrates clinical appropriateness).

Debridement of mycotic nails, no more than once every 2 months (unless documentation demonstrates clinical appropriateness), in the absence of a systemic condition above, is considered medically necessary when the following criteria are met:

1. For ambulatory individuals, pain results in difficulty walking and/or abnormality of gait in conventional walking footwear; or
2. In non-ambulatory individuals, there is pain or secondary infection resulting from the thickening and dystrophy of the infected toenail plate.

Surgical removal or care rendered as treatment of ingrown toenail(s) is considered medically necessary.

Not Medically Necessary:

Foot care services, including cutting or removal of corns or calluses, or trimming, cutting, clipping or debriding of nails (including mycotic nails) are considered not medically necessary when the criteria above are not met and for all other indications.

Cleaning and soaking of the feet is considered not medically necessary for all indications.