Podiatry Billing Exclusions

MPM a NJ Medical Billing Service on Podiatry Services

MPM a NJ Medical Billing Service has been billing Podiatry since 1996 located in Parsippany NJ and provides some insight on Podiatry billing exclusions. 

Exclusions to covered podiatry services

Certain foot care services aren't covered by Medicare, and may or may not be covered under general third-party insurance.

If you're billing for podiatry services, and they fall into these categories, you may be fighting a hopeless battle against your insurance company. They are, with certain exceptions noted:

• Routine Foot Care - Some exclusions to the outright denial of routine foot care services include:

  • initial care, for a service that may result in a covered diagnosis
  • the presence of a metabolic, neurologic, or peripheral vascular disease
  • Mycotic nails
  • or if the patient is under the care of a primary care physician for diabetes mellitus, chronic thrombophlebitis, or peripheral neuropathies (such as carcinoma, malnutrition, or multiple sclerosis)

• Flat foot - No exceptions

• Subluxation of the Foot - There are only 2 exceptions to this denial:

  1. that the subluxation (or dislocation) was of the ankle joint
  2. or for care that has resulted from the subluxation of structures within the foot.

• Supportive Devices of the Foot - Exceptions include orthotic shoes that are an integral part of a leg brace, or therapeutic shoes for those with diabetes.

• Therapeutic Shoes for Individuals with Diabetes - There is 1 exception to this denial, and it includes a narrow permit of special shoes and inserts for persons with diabetes.

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