Medicare Coverage Requirements

Routine Nail Care

Routine nail care is one of the many benefits of seeing a podiatrist when you have underlying health conditions. However, many private insurances and private Medicare providers (e.g., Anthem, Aetna, or Humana Medicare) follow Medicare guidelines to determine which services are covered.

Before you can be scheduled for a nail service appointment, please provide your podiatrist with office notes from your primary care provider that support one or more of the diagnoses required by Medicare. Below is a partial list:

• Atherosclerosis of native arteries of extremities (ICD-10: I70.2--)
• Phlebitis and thrombophlebitis of lower extremities (ICD-10: I80.--) *
• Chronic kidney disease (ICD-10: N18.--)*
• Type I or type II diabetes with neuropathy (ICD-10: E10.4-, E11.4-)*
• Type I or type II diabetes with peripheral angiopathy (ICD-10: E10.5-, E11.5-)*

*For these diagnoses, Medicare requires that the patient be under the active care of a doctor of medicine or osteopathy (M.D. or D.O.) for the treatment or evaluation of the disease during the 6-month period prior to receiving routine nail care.

Visit the Medicare Coverage Database for a complete list of qualifying conditions.

Your service will not be covered unless the required documentation is provided every six months to prove medical necessity.

We apologize for any inconvenience this may cause you. However, it is important that we comply with all Medicare requirements. We are happy to schedule you once it is confirmed that Medicare guidelines have been met.