Maximize your podiatry practice revenue with specialized billing expertise in diabetic foot care, routine care exclusions, and orthotic device billing. Our certified podiatric billing specialists understand Class finding documentation, medical necessity requirements, and complex foot care billing regulations.
Proven Results
26% Average Revenue Increase
96% First-Pass Claim Rate
46% Reduction in Denials
14 Days Faster Payment Collection
Common Billing Challenges
Routine Foot Care Exclusions
Medicare and many insurers do not cover routine foot care unless specific Class A-D systemic conditions are documented.
Diabetic Foot Care Documentation
Proving medical necessity for diabetic foot care requires precise documentation of Class findings, PAD, neuropathy, and qualifying conditions.
Nail Debridement vs Trimming
Distinguishing between covered nail debridement (mycotic nails, onychomycosis) and non-covered routine nail trimming is critical for compliance.
Class A-D Findings Requirements
Medicare requires documentation of specific Class A, B, C, or D findings for routine foot care coverage, which many practices struggle to properly document.
Orthotic Device Billing Complexity
Custom orthotics, accommodative inserts, and diabetic shoes have specific HCPCS codes, modifiers, and documentation requirements.
Surgical Procedure Coding
Bunionectomies, hammertoe corrections, and neuroma excisions require precise CPT coding with proper approach and extent modifiers.
Our Solutions
Podiatry-Certified Billing Specialists
Our team includes certified coders with specialized training in podiatric medicine, diabetic foot care, and routine care exclusion compliance.
Expert CPT coding for all podiatric procedures
Class finding documentation expertise
Routine care exclusion compliance
Diabetic foot care medical necessity validation
Diabetic Foot Care Documentation Support
Comprehensive guidance on documenting qualifying systemic conditions, Class findings, and medical necessity for diabetic foot care services.
Systemic condition documentation templates
Class A-D finding identification
PAD and neuropathy verification
Q-modifier application expertise
Orthotic Device Billing Expertise
Specialized knowledge of HCPCS codes for custom orthotics, diabetic shoes, and foot orthoses with proper modifier application.
Custom orthotic HCPCS coding (L3000 series)
Diabetic shoe program billing (A5500-A5514)
Modifier LT/RT application
Documentation for medical necessity
Surgical Procedure Optimization
Maximize reimbursement for bunionectomies, hammertoe repairs, and other foot surgeries with accurate CPT coding and global period management.
Surgical CPT code optimization
Multiple procedure modifier application
Global period tracking
Proper bilateral procedure coding
Specialized Services
Diabetic Foot Care Billing
Expert billing for diabetic wound care, neuropathy treatment, and routine foot care with proper Class finding documentation.
Diabetic wound debridement
Neuropathy management
Routine care with Class findings
Ulcer treatment coding
Nail & Skin Procedures
Accurate billing for nail debridement, mycotic nail treatment, callus removal, and wart destruction with medical necessity documentation.
Nail debridement (11720-11721)
Mycotic nail treatment (11730)
Callus removal (11055-11057)
Wart destruction (17110-17111)
Surgical Procedures
Comprehensive billing for bunionectomies, hammertoe corrections, neuroma excisions, and reconstructive foot surgery.
Bunionectomy procedures (28290-28299)
Hammertoe repair (28285)
Neuroma excision (28080)
Reconstructive surgery
Orthotics & DME Billing
Specialized billing for custom foot orthotics, diabetic shoes, AFOs, and other durable medical equipment.
Custom orthotic devices (L3000 series)
Diabetic shoe program
AFO billing (L1900 series)
Insert and modification billing
Common CPT Codes Reference
Key codes include 11720 (debridement of nails, 1-5), 11721 (debridement of nails, 6 or more), 11730 (nail plate avulsion, single), G0127 (trimming of dystrophic nails), 28285 (hammertoe correction), 28290-28299 (bunionectomy procedures by type), L3000 (foot insert, removable), A5500 (diabetic shoe fitting/dispensing), 11055-11057 (paring or cutting of benign hyperkeratotic lesions), and 28080 (excision of interdigital neuroma). Proper coding requires understanding of Medicare routine foot care exclusions, Class A-D finding documentation, and HCPCS modifiers for orthotics.
Expert Billing Insights
Medicare Class A-D Findings for Routine Foot Care Coverage
Medicare generally excludes routine foot care (nail trimming, callus removal) unless the patient has a qualifying systemic condition with documented Class A findings (non-traumatic amputation), Class B findings (absent posterior tibial or dorsalis pedis pulse), Class C findings (advanced peripheral neuropathy with loss of protective sensation), or Class D findings (pressure ulcer or pre-ulcerative callus). Proper documentation of Class findings with the corresponding Q-modifiers (Q7-Q9) is essential for coverage and can mean the difference between full reimbursement and a denied claim. Practices that implement systematic Class finding documentation protocols typically see a 20-30% increase in covered routine foot care services.
Document specific Class A-D findings in every encounter note for patients with qualifying systemic conditions
Apply Q7 (one Class A finding), Q8 (one Class B finding), or Q9 (one Class C finding) modifiers to routine foot care claims
Maintain a patient registry tracking qualifying diagnoses and Class findings to ensure consistent documentation across visits
Obtain and document the treating physician statement certifying the patient meets Medicare criteria for covered foot care
Diabetic Foot Care Documentation Best Practices
Billing diabetic foot care under Medicare requires documentation of the qualifying diabetic diagnosis, evidence of peripheral neuropathy or peripheral arterial disease, and certification that the patient is at risk of limb-threatening complications without professional foot care. The treating physician must certify the care plan, and documentation must include sensory testing results (monofilament, tuning fork), vascular assessment findings, and skin/nail condition descriptions. Incomplete diabetic foot care documentation is the leading cause of podiatry claim denials, with practices losing an estimated 15-25% of diabetic foot care revenue to documentation-related denials.
Perform and document monofilament testing and vascular assessments at every diabetic foot care visit
Obtain a signed physician certification statement for diabetic patients requiring routine foot care services
Link all foot care services to specific ICD-10 codes for diabetes with neurological or circulatory complications
Document the specific risk factors (history of ulceration, previous amputation, Charcot deformity) that justify ongoing foot care
Nail Debridement vs Routine Trimming Compliance
The distinction between covered nail debridement (11720-11721) and non-covered routine nail trimming is a major compliance risk area in podiatry billing. Nail debridement is covered when nails are dystrophic, mycotic (fungal), or thickened due to systemic disease, while routine trimming of normal nails is excluded from Medicare coverage. Documentation must clearly describe the nail pathology (thickness, discoloration, fungal involvement, onychomycosis culture results) and explain why professional debridement rather than routine trimming is medically necessary.
Document specific nail pathology descriptions (thickness in mm, discoloration, subungual debris, mycotic changes) for each nail treated
Distinguish between debridement of dystrophic nails (covered) and trimming of normal nails (non-covered) in documentation
Maintain fungal culture or KOH results to support mycotic nail diagnosis when billing nail debridement services
Use G0127 for trimming of dystrophic nails when performed by a non-physician provider under Medicare guidelines
Payer-Specific Billing Tips
Medicare Part B
Document Class A-D findings with corresponding Q-modifiers (Q7-Q9) for every routine foot care claim to establish medical necessity under Medicare coverage guidelines
Obtain and maintain current treating physician certification statements for diabetic patients requiring ongoing foot care services
Follow LCD requirements for nail debridement documentation, including specific nail pathology descriptions and systemic condition linkage
Bill diabetic shoe fitting and dispensing (A5500-A5514) separately from foot care services with proper physician prescription documentation
Medicare Advantage Plans
Verify MA plan-specific coverage policies for routine foot care, as some plans have additional documentation requirements beyond traditional Medicare
Check prior authorization requirements for surgical procedures (bunionectomy, hammertoe repair) which vary significantly between MA plans
Appeal denied routine foot care claims with complete Class finding documentation, as MA plan reviewers may apply stricter criteria than traditional Medicare
Document supplemental benefit coverage for routine foot care offered by some MA plans that extends beyond traditional Medicare coverage
Medicaid
Verify state-specific Medicaid coverage for podiatric services, as coverage varies dramatically from comprehensive to emergency-only across states
Check Medicaid managed care plan formularies for orthotic and DME coverage, as many plans require specific brand or supplier restrictions
Obtain prior authorization for surgical procedures through the state-specific Medicaid portal, following each state's unique authorization process
Bill routine foot care under Medicaid only when the state program covers podiatric preventive services and documentation meets state-specific requirements
Commercial Payers
Verify orthotic coverage limitations, as many commercial plans cap custom orthotic coverage at one pair per year or require step-therapy with OTC inserts first
Obtain pre-authorization for bunionectomy and hammertoe surgical procedures, documenting conservative treatment failure and functional limitations
Check DME benefits separately from medical benefits for diabetic shoes and custom orthotics, as coverage may fall under a separate DME rider
Document medical necessity for all foot care procedures with photographs, measurements, and functional impact assessments to prevent cosmetic exclusion denials
Client Testimonial
Podiatry billing is incredibly complex with routine care exclusions and Class finding
requirements. Medtransic's team has specialized podiatry expertise and helped us properly
document diabetic foot care with qualifying systemic conditions. Their guidance on routine
care exclusion compliance and orthotic billing has increased our collections by 28% while
eliminating compliance concerns.