Free podiatry tool
Routine foot care coverage checker
Answer questions on condition, findings and dates. Returns coverage likelihood, which Q modifier applies, whether active care is met, and the next payable date. Dropdowns, checkboxes and dates only. Nowhere to type patient data.
Class B
Class C
Full rule text and worked example
The statutory exclusion
Social Security Act section 1862(a)(13) excludes routine foot care from Medicare coverage. 42 CFR 411.15 defines what counts as routine: cutting or removing corns and calluses, trimming and debriding nails, and hygienic maintenance. Payment happens only through narrow exceptions.
Worked example
Patient with type 2 diabetes (E11.9, specified). Left foot: absent posterior tibial pulse and absent dorsalis pedis pulse. Last managing physician visit for diabetes: 3 months ago. Last nail debridement: 70 days ago. Planned service: today. Result: Q8 (two Class B findings), active care met (within 6 months), frequency met (over 60 days). Likely covered, assuming your contractor accepts the diagnosis and does not tighten the interval.
Common failure
Same patient, but the managing physician visit was 7 months ago. The note is perfect, class findings are documented, the modifier is correct. The claim is non-payable because the active-care date lapsed. Check the date at scheduling, not at claim submission.
Educational only. Not billing, coding, legal or medical advice. Coverage changes. Do not enter patient information. This tool neither needs nor accepts it. Verify every result against your contractor's current article. Tool rule set needs compliance and legal review.
This tool is also embedded on the Podiatry specialty page.