Medicare Rules on Nail Debridement

Medicare has rules about nail debridement.

Medicare doesn't always cover the situations we think it should. Foot care is vital to anyone on Medicare because problems limit mobility and independence. Often, people on Medicare don't have the money for treatments for their feet. It's important to know what Medicare covers and what it doesn't.

Definition of Nail Debridement

Medicare uses a definition of nail debridement approved by the American Podiatric Medical Association. It says that "nail debridement involves the removal of excessive nail material (i.e., the reduction of nail thickness or bulk) from clinically thickened, diseased (e.g., mycotic or dystrophic) nail plate that may or may not also be misshapen in appearance or brittle in characteristic." The debridement treatment itself involves shortening and thinning the nail with a grinder or by manual methods.

Things Medicare Covers

Medicare will only pay for nail debridement when performance of the debridement will entail danger to the health of the patient; that is, when it can't be done safely by the patient or the patient's non-medical caregiver. This situation results from a peripheral vascular, metabolic or neurological disease. Routine services usually performed by the patient or the non-medical caregiver will be covered if they are part of a covered disease or treatment. If there is no systemic illness, Medicare will cover the treatment if there is fungal infection of the toenail or the patient has trouble walking.

Things Medicare Doesn't Cover

If it can be called routine care, Medicare won't cover it. As a practical matter, this means cutting or removal of corns and calluses, the removal of warts if it can be done in a non-medical setting, cleaning or soaking or the application of creams to the feet or anything that concerns the feet where there is no localized injury or illness.

References

• Medicare A Bulletin: Draft - Routine Foot Care And Debridement Of Nails
• The Free Dictionary: Debridement