What Well-known, Traditional, "Fee for Service" Medicare usually EXCLUDES

• All items which are TOTALLY disallowed by the terms of the Medicare program;
• The full, annual "deductible" AND "20% co-insurance" for each and every "covered" service's "allowed amount" which must be paid to the provider of the service unless your "Medigap" type plan pays the provider; if the latter does not, you must pay;
• UNqualified "ROUTINE" foot care, such as the cutting of corns or calluses and the trimming of toenails in a patient who is not "at significant risk";
• Routine foot care (RFC) for "qualified" conditions if provided MORE frequently than every 60+ days.  If non-RFC is provided again 59 days (or sooner) since the last non-RFC, it is NOT covered (The patient must personally pay.);
• Uncomplicated THICK toenails in the ABSENCE of foot / toe pain in shoes while trying to walk, or, in the case of the non-walking person, in the absence of complicating risks;
• "FLAT-FOOT" conditions nor its care with the use of foot supports or orthotics, or supportive devices inside shoe gear;
• The treatment of partial dislocations (subluxations) or symptoms-producing structural problems or malalignments;
• "Orthopedic" or molded shoes, unless attached to a ankle/leg brace or in the absence of specific qualifying conditions (e.g. diabetic conditions such as clinically confirmed, advanced peripheral vascular and/or neurological disorders);
• Simple"hygienic" foot care, such as whirlpool foot baths just to soften corns, calluses or toenails or to just clean the toes and feet or the simple applications of skin conditioners or moisturizers;
• Additional, related surgical foot care more frequently than once every 90 days, unless for an unrelated problem (some exceptions for "lesser" surgical procedures);
• "Preventative care" of the toes, feet and ankles; necessary, therapeutic care is usually covered;
• Prescription drugs outside of a hospital (Though the nominal "Part-D Medicare" may.)
• Cosmetic surgery; Medicare does not care how unattractive you feet may be;
• Non-covered, personal comfort-care, health/beauty aids or products, and non-integral, secondary, post-surgical or medical supplies;
• UNnecessary services, be they at home, office, hospital, surgical center or extended care facility;
• All services provided to a member of a "Medicare HMO" (health maintenance organization) or of a "Medicare Advantage" type plan when received "outside" of those non-traditional plans by a non-participating provider, unless express authorization or permission from those plans is obtained in advance. If you join one of these non-traditional Medicare-like plans, you NO LONGER have traditional Medicare!

If you have any additional questions about what is excluded (or what is included), refer to your Medicare Handbook, available from Medicare or its local claims processor, currently, NGS - National Government Services. Refer to your Medicare card and/or look them up in the telephone book. Be sure to insist that they mail to you a printed copy (sheet, pamphlet or booklet) of whatever they tell you over the phone. Be sure to get the name and ID number the person who is providing you the information. Don't hesitate to insist to talk to that person's supervisor if you are in doubt.

What Well-known, Traditional, "Fee for Service" Medicare usually INCLUDES

• Medical Office visits (for the history taking, evaluation, planning, medical management) for possible, significant foot symptoms and conditions requiring such attention;
• Medical and surgical care which is "medically necessary" only and not just cosmetic or hygienic;
• True foot surgery (cutting into the foot, attempting to fix a significant problem there, removing or destroying unfavorable tissues, etc., repairing the wound and providing a certain amount of covered post-op care) for impacting a medically significant condition; (This is NOT to be confused with trimming of corns, calluses or nails, or hygiene measures);
• Medically necessary injections (a type of 'surgery') for diagnosis of a condition or for its treatment;
• X-rays, MRI, CAT/CT, and bone scans and similar 'imaging" of the foot for diagnosis of conditions;
• Certain diagnostic tests, blood testing, vascular (circulation) or neurological (nerve), tissue biopsy testing for diagnosis, evaluation of a condition and for surgical planning;
• Many services provided by registered Physical Therapists at the direction of podiatrist (e.g. ultrasound treatments);
• Significantly thick toenails which cause painful walking when in shoes accompanied by some evidence of inflammation at the painful nail(s), or, if these nails are a health risk to a non-walking person;
• Prescriptions for all appropriate medications for the treatment of significant foot conditions;
• Prescriptions for MD-ok'd s,pecial, therapeutic depth-inlay, diabetic shoes (with or without multidensity insoles) for feet with particular diabetic complications, but NOT for uncomplicated diabetes;.
• Ordinarily, the removal of corns or calluses is not deemed 'medically necessary" by Medicare and thus is not a covered service. However, in the clinical presence of specific findings, the otherwise non-covered routine foot care elevated to the status of at-risk foot care (ARC) which may be covered:

  • "Routine" foot care may be covered only if you are under the concurrent care of a physician who you have seen within the last six [6] months for at least one of the following:

  • Concurrent use of the anticoagulant warfarin (e.g., Coumadin);
  • Diabetes only IF WITH Medicare-specified clinical findings of complications;
  • Bad blood flow into the foot (signs of arteriosclerosis) [six-month rule does NOT apply here]
  • Amputation of a toe or toes from one or both of your feet and / or amputation of part of one or both of your feet due to impaired circulation within the feet
  • Bad blood flow out of the feet (e.g., chronic venous insufficiency);
  • Bad perception of nerve sensations (peripheral neuropathy) associated with Medicare-specified clinical findings of this complication;
  • One of several other, infrequent conditions based on Medicare-specified clinical findings of significant complications.

1. See and be examined by your physician at least every six months or more frequently;
2. Provide your podiatrist, at each office visit, the date you had actually been under your physician care that condition or had a laboratory test the physician ordered for the management of that risky condition.

Dr.Ken Sokolowski