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MEDICARE Basics and Podiatry

Information From The American Podiatric Medical Association


Podiatric Medicine

Podiatric medicine is a branch of the health sciences devoted to the medical and surgical care of the foot and ankle, and related or governing structures. A doctor of podiatric medicine (DPM) specializes in the prevention, diagnosis, and treatment of foot and ankle disorders resulting from injury or disease. A DPM makes independent medical judgments, prescribes medications, and when necessary performs surgery.

Podiatrists help our aging population to remain active and independent by keeping them ambulatory. Congress recognized this important relationship between foot health and general health when it included the services of podiatric physicians in the Medicare legislation.

Misconceptions of Medicare

Medicare coverage can often be confusing. The rules and regulations can easily be misunderstood by patients. One misconception is that Medicare covers only surgical procedures, and not medical care or routine foot care.

In truth, Medicare will cover routine foot care. According to the Medicare Rules and Regulations Manual, "Certain foot care procedures that are generally considered to be routine -- e.g., cutting or removal of nails, calluses or corns -- may pose a hazard when performed by a nonprofessional person on patients with a systemic condition that has resulted in severe circulatory problems or areas of desensitization in the legs or feet. Routine foot care performed under these circumstances is covered."

The manual also states, "Services ordinarily considered routine are also covered if they are performed as a necessary and integral part of otherwise covered services such as the diagnosis and treatment of diabetic ulcers, wounds, and infections."

Treatment of diabetic foot conditions, both medically and surgically, is therefore covered by Medicare. Treatment of broken toes, of burns, and of arthritic conditions -- gout, for example -- are others. (The misconceptions that Medicare covers only surgery may be caused by the fact that the Medicare code numbers assigned to diabetic treatment such as that mentioned in the manual, and other nonsurgical procedures, are listed under the "surgical" section of the code book.)

Coverage Under Medicare

If you have signed up for medical insurance (Part B) under Medicare, you are covered for certain services of podiatrists and other doctors for:

  1. Medical and surgical services in the hospital, skilled nursing facility, office, or your home. The same action also provided that podiatrists can certify and recertify medical necessity for hospitalization, skilled nursing care, and home health care.
  2. Payment for routine foot care may be made for such care only when it would be hazardous to the health of the patient if self-treatment were performed. For example, when a beneficiary is under the care of a doctor for diabetes, circulatory ailments or certain other conditions, and evidences complicating local symptoms, routine foot care is a covered service.
  3. Other prescribed health services, including diagnostic x-ray, surgical treatment, fracture casts, and leg or ankle braces that are attached to the outside of the shoe.
  4. Drugs which cannot be self-administered, and which are administered to you as a part of professional services.
  5. Full reasonable charges for radiology and pathology services as a bed patient in a hospital, if you have both hospital and medical insurance.

Certain foot care services are not covered, no matter whether they are performed by podiatrists, medical doctors, or osteopaths. They are:

  1. Routine foot care. This includes the cutting or removal of corns or calluses, trimming of nails, and routine hygienic care, except as noted above.
  2. Treatment of flat-foot conditions, including arch supports.
  3. Treatment of partial dislocations.

Reimbursement Under Medicare

Your medical insurance (Part B of Medicare) helps pay for the services of podiatrists and other doctors, out-patient hospital services, medical services and supplies, and other health care services.

Subscribers to medical insurance pay a monthly premium, and the Federal government covers the remaining costs of the program. Medical insurance pays 80 percent of the Medicare-allowed amount, after the individual pays an annual deductible for covered services connected with the diagnosis or treatment of illness and injuries. Payment for services of a podiatrist or another doctor can be made as follows:

  1. 1. If you and your podiatrist agree, application for the medical insurance payment for covered services will be made by the podiatrist who will receive the payment directly from Medicare.
  2. If you desire it, you may pay the doctor directly, and the medical insurance payment can be made directly to you.

In either case, you are responsible for the annual deductible and the 20 percent coinsurance amounts. Under either of these two payment options, the podiatrist is required to complete the necessary Medicare claim forms for you.

Note that, in some cases, you may also be charged amounts in excess of the Medicare-allowed fees, and for services not covered under the Medicare program.

See "Your Medicare Handbook" for more information.

Prompt Care Of Foot Disorders

With advancing years, the skin and nails of the feet frequently become dry and brittle, and numbness and discoloration often are present. These may be the first signs of such serious conditions as diabetes, arthritis, and circulatory disease. Ignoring these symptoms and failing to seek prompt professional medical care when they appear can have serious consequences for patients, especially the elderly.

Foot Problems Can Be Prevented

Whether the older person lives at home or elsewhere, preventive foot care can:

bulletIncrease comfort
bulletImprove or maintain mobility and independence
bulletLimit the possibility of additional medical problems
bulletReduce the chances of hospitalization
bulletLessen requirements for other institutional care

Consult Your Podiatrist

You may receive treatment from your podiatrist in the office, your home, the hospital, a nursing home, or an extended care facility. Always consult your podiatrist when you have questions about foot conditions or what is covered by Medicare.

 

Reprinted with permission from the American Podiatric Medical Association

 

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Last modified: 10/13/10