25-273m Reimbursement Update for Routine Foot Care
Date: 03/20/25
Benefits align with state rules and CMS guidance for Ambetter HMO and PPO
Effective January 1, 2025, routine foot care benefits follow guidelines set by state mandates and the Centers for Medicare & Medicaid Services (CMS). Health Net reimburses providers in the Ambetter HMO and PPO networks for routine foot care based on state rules and CMS guidelines.
CMS identifies routine foot care procedures by the following codes
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Code | Description |
|---|---|
11719 | Trimming of nondystrophic nails, any number |
11720 | Debridement of nail(s) by any method(s); 1 to 5 |
11721 | Debridement of nail(s) by any method(s); 6 or more |
G0127 | Trimming of dystrophic nails, any number |
11055 | Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion |
11056 | Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); 2 to 4 lesions |
11057 | Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); more than 4 lesions |
G04271 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
S03901 | Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit |
For additional detail on CMS billing and coding guidance for routine footcare care, please visit Billing and Coding: Routine Foot Care.
Modifiers to use
To ensure correct billing and accurate cost-sharing for routine footcare services, apply the following code modifiers:
- Q7 – One Class A finding
- Q8 – Two Class B findings
- Q9 – One Class B and two Class C findings
Provider scope and other considerations
Routine foot care services are not limited to podiatrists. Any certified physician or non-physician provider (NPP) can offer these services. Other medical services may require cost share depending on the provider type billing (such as surgical, specialist, doctor or facility).
As a reminder, please refer to the Commercial Prior Authorization Requirements to verify which services require prior authorization for Ambetter HMO and PPO.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
1G0427 and S0390 are not part of the CMS guidance, however these are considered part of routine foot care.
Provider Services
Line of business | Phone number |
|---|---|
| Ambetter from Health Net IFP - Ambetter PPO | |
Ambetter from Health Net IFP - Ambetter HMO |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.