Podiatry practices face numerous challenges in their billing operations. Professional coders must meet specific coding guidelines to receive reimbursement from insurance companies. To add to it, insurance providers require their own set of regulations and documentation preferences that you must meet if you want to maintain a clean claim submission track.

The world of podiatry billing updates regularly, making it challenging for healthcare professionals to keep up with the best billing practices.

At Weave, we provide podiatry software for accurate medical coding, efficient claims submissions, and fast payments. Use our quick reference guide below as a billing and coding cheat sheet for your podiatry practice.

What’s Covered: Medicare and Private Insurance

Medicare

The Centers for Medicare and Medicaid Services clearly defines what services it will and will not cover for its patients. While Medicare does not directly dictate what private insurers cover, it does influence the overall guidelines through its Correct Coding Initiative and other efforts.

In general, Medicare will cover medical necessity treatments or reasonable foot care services provided by your clinic. With that being said, providers will only receive a Medicare payment if they can prove the treatment’s medical necessity by meeting Medicare’s strict terms. Medicare’s terms restrict coverage on frequent services, stipulate guidelines on the treatment setting, and require specific diagnosis codes.

Assuming all criteria are met, Medicare covers the following podiatric services:

  • Foot care treatments for patients with chronic conditions
  • Wound care treatments
  • Hyperbaric oxygen therapy for specific wounds on the lower extremities
  • Treatments on warts

Medicare will not cover elective podiatry services that do not fall under the category of reasonable foot care. Additional treatments that Medicare may not cover include the following:

  • Routine check-up services that are not part of an initial check-up that may result in a diagnosis (excluding exams Q8 codes relating to metabolic conditions, neurologic issues, or peripheral vascular disease)
  • Foot subluxation
  • Flat foot treatment
  • Supportive devices (excluding orthotic shoes as part of a leg brace and therapeutic shoes for diabetic patients)

 

Private Insurance

Private insurance companies create their own exclusive policies on which podiatry claims they cover. Each insurance company has a range of specific coverages, exclusions, restrictions, and clauses that can make it challenging to understand which covered services your practice can and cannot offer to patients. 

Every organization varies coverage based on the individual’s plan, medically appropriate history, local coverage determinations, prior authorization terms, and more.

In general, private insurers follow the same guiding principles that Medicare sets for podiatry billing and coding coverage. Of course, some insurance providers may cover inclusive procedures, while others may deny these additional procedure codes.

For a general view of what private insurers cover, we will look at Blue Cross Blue Shield Association, which provides insurance to over 115 million people in the United States. Blue Cross Blue Shield covers multiple procedures and treatments.

With accurate coding, Blue Cross Blue Shield covers the following:

  • Diabetic foot treatments
  • Fungal nail services
  • Foot and ankle surgical correction
  • Treatment for ankle or foot injuries
  • Wart treatments
  • Durable medical equipment
  • Aspiration or injections
  • And more

Blue Cross Blue Shield and other private insurers may deny medical claims relating to elective treatments.

Essential Podiatry Medical Billing Codes

Use this comprehensive list of essential podiatric medicine codes below as a quick reference guide.

Routine Foot Care Services

Podiatry coding on in-clinic procedures and toenail treatments:

  • 99203 – 99204: New patient office visits
  • 99213 – 99214: Established patient office visits
  • 29405: Short leg cast application (non-weight bearing)
  • Q4038: Short leg cast material
  • 20550: Injection tendon sheath/ligament
  • J3301: Triamcinolone acetonide treatment
  • 11720: Toenail trim (1 foot)
  • 11721: Toenail trim (2 feet)
  • 11730: Toenail removal

 

Surgical Procedures

Procedure codes:

  • 11750: Permanent toenail removal
  • 97597: Open wound debridement
  • 17110: Benign wart or lesion removals (up to 14)
  • 28450: Treatment of bone fracture
  • 12001: Simple superficial wound repair (2.5 cm or less)
  • 28285: Hammertoe correction

 

Orthotic Treatments

Submitting claims on orthotic treatments:

  • L3020: Custom orthotic materials (OR002)
  • 29799: Casting impression fitting (S0395)
  • 97760: Orthotic management and training (15 minutes per Durable Medical Equipment)
  • L4360: Ottobock Pneumatic Walker (immobilizing boot) (SS406)
  • L4396: Treatment for plantar fasciitis (foot night splint) (SS397)
  • L1902: Ankle brace (SS243)

 

The Role of Weave’s Technology in Simplifying Podiatry Billing

Maintaining successful coding efforts and avoiding unpaid claims at your podiatry clinic can become overwhelmingly time-consuming and complex.

At Weave, we offer software that streamlines medical billing and insurance verification by automating the coding process. Your team can keep track of up-to-date medical records, easily report each necessary procedure code, and skip the hassle of time-consuming medical billing so you can spend more quality time with patients.

At Weave, we’ve based our solution on the reported complexities in the podiatry billing population. If you want to streamline how your clinic operates for faster claims submissions and increased payment acceptance rates, you’ve come to the right place.

Get a demo of Weave’s comprehensive solutions to optimize your podiatry billing processes today.

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Podiatry Billing and Coding FAQs

[saswp_tiny_multiple_faq headline-0=”h3″ question-0=”What Are CPT Codes in Podiatry Billing?” answer-0=”CPT codes provide additional information to the health insurance company regarding the patient’s condition. These codes are two-digit, level-one modifiers that medical billing coders must include in coding documentation for successful claims. For podiatry services, medical professionals use CPT codes Q7, Q8, and Q9.” image-0=”” headline-1=”h3″ question-1=”What Is the Q8 Modifier Used For?” answer-1=”The CPT code Q8 reports the presence of two class-B findings relating to routine foot care, such as a secondary infection resulting from an infected toenail plate. Class B findings include systematic conditions like metabolic conditions, neurologic issues, or peripheral vascular diseases that impact the circulation in the individual’s feet or legs. Class B findings often require treatment but are not as severe as Class A reports.” image-1=”” headline-2=”h3″ question-2=”How Often Will Medicare Cover 11721?” answer-2=”Medicare will cover the podiatry billing code 11721 (for nail debridement) up to six times a year, assuming the patient meets the required conditions. The code requires a Q8 modifier, implying a systematic condition and routine check-ups for coverage.” image-2=”” count=”3″ html=”true”]