ROUTINE FOOT CARE. Policy Number: OUTPATIENT T1 Effective Date: October 1, 2016

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1 Oxford ROUTINE FOOT CARE UnitedHealthcare Oxford Clinical Policy Policy Number: OUTPATIENT T1 Effective Date: October 1, 2016 Table of Contents Page INSTRUCTIONS FOR USE... 1 CONDITIONS OF COVERAGE... 1 BENEFIT CONSIDERATIONS... 1 COVERAGE RATIONALE... 2 APPLICABLE CODES... 2 REFERENCES POLICY HISTORY/REVISION INFORMATION Related Policy Durable Medical Equipment, Orthotics, Ostomy Supplies, Medical Supplies, and Repairs/ Replacements INSTRUCTIONS FOR USE This Clinical Policy provides assistance in interpreting Oxford benefit plans. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage members. Oxford reserves the right, in its sole discretion, to modify its policies as necessary. This Clinical Policy is provided for informational purposes. It does not constitute medical advice. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies. When deciding coverage, the member specific benefit plan document must be referenced. The terms of the member specific benefit plan document [e.g., Certificate of Coverage (COC), Schedule of Benefits (SOB), and/or Summary Plan (SPD)] may differ greatly from the standard benefit plan upon which this Clinical Policy is based. In the event of a conflict, the member specific benefit plan document supersedes this Clinical Policy. All reviewers must first identify member eligibility, any federal or state regulatory requirements, and the member specific benefit plan coverage prior to use of this Clinical Policy. Other Policies may apply. UnitedHealthcare may also use tools developed by third parties, such as the MCG Care Guidelines, to assist us in administering health benefits. The MCG Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice. CONDITIONS OF COVERAGE Applicable Lines of Business/ Products Benefit Type Referral Required (Does not apply to non-gatekeeper products) Authorization Required (Precertification always required for inpatient admission) Precertification with Medical Director Review Required Applicable Site(s) of Service (If site of service is not listed, Medical Director review is required) Special Considerations This policy applies to Oxford Commercial plan membership. General benefits package Yes - Office No - Home, Outpatient Yes - Home, Outpatient No - Office No Home, Outpatient, Office Routine foot care is excluded from coverage for all Commercial plans except as outlined in the Coverage Rationale section of this policy. BENEFIT CONSIDERATIONS Before using this policy, please check the member specific benefit plan document and any federal or state mandates, if applicable. Routine Foot Care Page 1 of 23

2 Essential Health Benefits for Individual and Small Group For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits ( EHBs ). Large group plans (both self-funded and fully insured), and small group ASO plans, are not subject to the requirement to offer coverage for EHBs. However, if such plans choose to provide coverage for benefits which are deemed EHBs, the ACA requires all dollar limits on those benefits to be removed on all Grandfathered and Non-Grandfathered plans. The determination of which benefits constitute EHBs is made on a state by state basis. As such, when using this policy, it is important to refer to the member specific benefit plan document to determine benefit coverage. COVERAGE RATIONALE Routine foot care for members with diabetes or who are at risk for neurological or vascular disease arising from diseases such as diabetes is covered. Benefit Limitations and Exclusions Routine care of the foot is an exclusion except when rendered to members with diabetes or members who are at risk of neurological or vascular disease arising from diseases such as diabetes. Examples of routine foot care include but are not limited to: o Cutting or removal of corns and calluses; nail trimming, cutting, or debriding o Hygienic and preventive maintenance foot care such as cleaning and soaking the feet, applying skin creams to maintain skin integrity and other services that are performed when there is not a localized illness, injury, or symptom involving the feet. This can take place in the physician office, outpatient setting, or member s home. Foot care services that are exclusions include (not an all-inclusive list): o Treatment of flat feet o Treatment of subluxation of the foot The following items are excluded from coverage, regardless of diagnosis. However, state mandates may apply. Refer to member specific benefit plan document and state mandates. o Shoes (standard or custom) o Shoe orthotics o Shoe inserts o Arch supports APPLICABLE CODES The following list(s) of procedure and/or diagnosis codes is provided for reference purposes only and may not be all inclusive. Listing of a code in this policy does not imply that the service described by the code is a covered or noncovered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies may apply. Coding Clarification: Routine Foot Care: CPT codes 11055, 11056, and will also be covered when billed with one of the diabetes and neurological or vascular disease diagnosis codes listed below and any one of the following routine foot care diagnosis codes: B35.3, L84, L60.1-L60.5, L60.8, L62, or M21.6X9. Nail Trimming Cutting or Debriding: CPT codes 11719, 11720, and 11721are covered when billed with a diabetes and neurological or vascular disease diagnosis code below. Shoe, Shoe Orthotic/Inserts, Arch Supports: When an Oxford Member certificate of coverage indicates orthotics are excluded from coverage, this refers to shoe inserts (including diabetic show inserts) unless there is language within the exclusion clause to indicate otherwise. The following codes will not be covered unless the members plan includes coverage for foot orthotics. Please refer to the member specific benefit plan documentation for additional information. CPT Code Routine Foot Care Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); 2 to 4 lesions Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); more than 4 lesions Nail Trimming Cutting or Debriding Trimming of nondystrophic nails, any number Routine Foot Care Page 2 of 23

3 CPT Code Nail Trimming Cutting or Debriding Debridement of nail(s) by any method(s); one to five Debridement of nail(s) by any method(s); six or more Treatment for Flat Feet (excluded from coverage) HCPCS Code Routine Foot Care G0247 S0390 Nail Trimming Cutting or Debriding Shoes G0127 A5500 A5501 A5503 A5504 A5505 A5506 A5507 A5508 L3201 L3202 L3203 L3204 L3206 L3207 L3215 L3216 L3217 L3219 L3221 L3222 L3230 L3250 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (e.g., flatfoot correction) CPT is a registered trademark of the American Medical Association Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include the local care of superficial wounds (i.e., superficial to muscle and fascia) and at least the following, if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails 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 Trimming of dystrophic nails, any number For diabetics only, fitting (including follow-up) custom preparation and supply of offthe-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe For diabetics only, fitting (including follow-up) custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with wedge(s), per shoe For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with metatarsal bar, per shoe For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with off-set heel(s), per shoe For diabetics only, not otherwise specified modification (including fitting) of off-theshelf depth-inlay shoe or custom molded shoe, per shoe For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe Orthopedic shoe, oxford with supinator or pronator, infant Orthopedic shoe, oxford with supinator or pronator, child Orthopedic shoe, oxford with supinator or pronator, junior Orthopedic shoe, hightop with supinator or pronator, infant Orthopedic shoe, hightop with supinator or pronator, child Orthopedic shoe, hightop with supinator or pronator, junior Orthopedic footwear, ladies shoe, oxford, each Orthopedic footwear, ladies shoe, depth inlay, each Orthopedic footwear, ladies shoe, hightop, depth inlay, each Orthopedic footwear, mens shoe, oxford, each Orthopedic footwear, mens shoe, depth inlay, each Orthopedic footwear, mens shoe, hightop, depth inlay, each Orthopedic footwear, custom shoe, depth inlay, each Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each Routine Foot Care Page 3 of 23

4 Shoes HCPCS Code L3251 L3252 L3253 Foot, shoe molded to patient model, silicone shoe, each Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, each Foot, molded shoe plastazote (or similar), custom fitted, each Routine Foot Care Page 4 of 23

5 HCPCS Code Shoe Orthotics/Shoe Inserts Routine Foot Care Page 5 of 23

6 E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication E E E E E E E E E E E E E E E E E E E E E E E E E Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, bilateral Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, left eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, right eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, right eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, left eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, bilateral Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, right eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, left eye Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, bilateral Routine Foot Care Page 6 of 23

7 E E E E E E E E E E E E E E E E E E E E E E E E Diabetes mellitus due to underlying condition with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye with macular edema, right eye with macular edema, left eye with macular edema, bilateral with macular edema, unspecified eye with traction retinal detachment involving the macula, right eye with traction retinal detachment involving the macula, left eye with traction retinal detachment involving the macula, bilateral with traction retinal detachment involving the macula, unspecified eye with traction retinal detachment not involving the macula, right eye with traction retinal detachment not involving the macula, left eye with traction retinal detachment not involving the macula, bilateral with traction retinal detachment not involving the macula, unspecified eye with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, right eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, left eye Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, bilateral Diabetes mellitus due to underlying condition with stable proliferative diabetic retinopathy, unspecified eye without macular edema, right eye without macular edema, left eye without macular edema, bilateral Routine Foot Care Page 7 of 23

8 E without macular edema, unspecified eye E08.36 Diabetes mellitus due to underlying condition with diabetic cataract E08.37X1 E08.37X2 E08.37X3 E08.37X9 E08.39 Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, right eye Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, left eye Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, bilateral Diabetes mellitus due to underlying condition with diabetic macular edema, resolved following treatment, unspecified eye Diabetes mellitus due to underlying condition with other diabetic ophthalmic complication E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified E08.41 Diabetes mellitus due to underlying condition with diabetic mononeuropathy E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy E08.43 Diabetes mellitus due to underlying condition with diabetic autonomic (poly)neuropathy E08.44 Diabetes mellitus due to underlying condition with diabetic amyotrophy E08.49 E08.51 E08.52 Diabetes mellitus due to underlying condition with other diabetic neurological complication Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene E08.59 Diabetes mellitus due to underlying condition with other circulatory complications E Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy E Diabetes mellitus due to underlying condition with other diabetic arthropathy E Diabetes mellitus due to underlying condition with diabetic dermatitis E Diabetes mellitus due to underlying condition with foot ulcer E Diabetes mellitus due to underlying condition with other skin ulcer E Diabetes mellitus due to underlying condition with other skin complications E Diabetes mellitus due to underlying condition with periodontal disease E Diabetes mellitus due to underlying condition with other oral complications E Diabetes mellitus due to underlying condition with hypoglycemia with coma E Diabetes mellitus due to underlying condition with hypoglycemia without coma E08.65 Diabetes mellitus due to underlying condition with hyperglycemia E08.69 Diabetes mellitus due to underlying condition with other specified complication E08.8 Diabetes mellitus due to underlying condition with unspecified complications E08.9 Diabetes mellitus due to underlying condition without complications E09.00 Drug or chemical induced diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E09.01 Drug or chemical induced diabetes mellitus with hyperosmolarity with coma E09.10 Drug or chemical induced diabetes mellitus with ketoacidosis without coma E09.11 Drug or chemical induced diabetes mellitus with ketoacidosis with coma E09.21 Drug or chemical induced diabetes mellitus with diabetic nephropathy E09.22 Drug or chemical induced diabetes mellitus with diabetic chronic kidney disease E09.29 Drug or chemical induced diabetes mellitus with other diabetic kidney complication Routine Foot Care Page 8 of 23

9 E E E E E E E E E E E E E E E E E E E E E E E E E E Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy with macular edema Drug or chemical induced diabetes mellitus with unspecified diabetic retinopathy without macular edema Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral Drug or chemical induced diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Drug or chemical induced diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Drug or chemical induced diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Routine Foot Care Page 9 of 23

10 E E E E E E E E E E E E E E E E E E E E E E E E with macular edema, right eye with macular edema, left eye with macular edema, bilateral with macular edema, unspecified eye with traction retinal detachment involving the macula, right eye with traction retinal detachment involving the macula, left eye with traction retinal detachment involving the macula, bilateral with traction retinal detachment involving the macula, unspecified eye with traction retinal detachment not involving the macula, right eye with traction retinal detachment not involving the macula, left eye with traction retinal detachment not involving the macula, bilateral with traction retinal detachment not involving the macula, unspecified eye with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, right eye Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, left eye Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, bilateral Drug or chemical induced diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye without macular edema, right eye without macular edema, left eye without macular edema, bilateral without macular edema, unspecified eye E09.36 Drug or chemical induced diabetes mellitus with diabetic cataract Routine Foot Care Page 10 of 23

11 E09.37X1 E09.37X2 E09.37X3 E09.37X9 E09.39 E09.40 E09.41 E09.42 E09.43 E09.44 E09.49 Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, right eye Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, left eye Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral Drug or chemical induced diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye Drug or chemical induced diabetes mellitus with other diabetic ophthalmic complication Drug or chemical induced diabetes mellitus with neurological complications with diabetic neuropathy, unspecified Drug or chemical induced diabetes mellitus with neurological complications with diabetic mononeuropathy Drug or chemical induced diabetes mellitus with neurological complications with diabetic polyneuropathy Drug or chemical induced diabetes mellitus with neurological complications with diabetic autonomic (poly)neuropathy Drug or chemical induced diabetes mellitus with neurological complications with diabetic amyotrophy Drug or chemical induced diabetes mellitus with neurological complications with other diabetic neurological complication Routine Foot Care Page 11 of 23

12 E E E E E E E E E E E E E E E E E E E E E E E E E E Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral Type 1 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Type 1 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Type 1 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye Routine Foot Care Page 12 of 23

13 E E E E E E E E E E E E E E Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Type 1 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Type 1 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E E E E E Type 1 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye E10.36 Type 1 diabetes mellitus with diabetic cataract E10.37X1 E10.37X2 E10.37X3 E10.37X9 Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral Type 1 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified Routine Foot Care Page 13 of 23

14 E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy Routine Foot Care Page 14 of 23

15 E E E E E E E E E E E E E E E E E E E E E E E E E E Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, left eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, bilateral Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, unspecified eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, right eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, left eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, bilateral Routine Foot Care Page 15 of 23

16 E E E E E Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment not involving the macula, unspecified eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, right eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, left eye Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, bilateral Type 2 diabetes mellitus with proliferative diabetic retinopathy with combined traction retinal detachment and rhegmatogenous retinal detachment, unspecified eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, right eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, left eye E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, bilateral E E E E E Type 2 diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye E11.36 Type 2 diabetes mellitus with diabetic cataract E11.37X1 E11.37X2 E11.37X3 E11.37X9 Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, right eye Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, left eye Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, bilateral Type 2 diabetes mellitus with diabetic macular edema, resolved following treatment, unspecified eye E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy E11.44 Type 2 diabetes mellitus with diabetic amyotrophy E11.49 Type 2 diabetes mellitus with other diabetic neurological complication E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E11.59 Type 2 diabetes mellitus with other circulatory complications E Type 2 diabetes mellitus with diabetic neuropathic arthropathy E Type 2 diabetes mellitus with other diabetic arthropathy E Type 2 diabetes mellitus with diabetic dermatitis E Type 2 diabetes mellitus with foot ulcer E Type 2 diabetes mellitus with other skin ulcer E Type 2 diabetes mellitus with other skin complications E Type 2 diabetes mellitus with periodontal disease Routine Foot Care Page 16 of 23

17 E Type 2 diabetes mellitus with other oral complications E Type 2 diabetes mellitus with hypoglycemia with coma E Type 2 diabetes mellitus with hypoglycemia without coma E11.65 Type 2 diabetes mellitus with hyperglycemia E11.69 Type 2 diabetes mellitus with other specified complication E11.8 Type 2 diabetes mellitus with unspecified complications E11.9 Type 2 diabetes mellitus without complications E13.00 Other specified diabetes mellitus with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E13.01 Other specified diabetes mellitus with hyperosmolarity with coma E13.10 Other specified diabetes mellitus with ketoacidosis without coma E13.11 Other specified diabetes mellitus with ketoacidosis with coma E13.21 Other specified diabetes mellitus with diabetic nephropathy E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease E13.29 Other specified diabetes mellitus with other diabetic kidney complication E E E E E E E E E E E E E E E E E E Other specified diabetes mellitus with unspecified diabetic retinopathy with macular edema Other specified diabetes mellitus with unspecified diabetic retinopathy without macular edema Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, unspecified eye Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral Other specified diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, right eye Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, left eye Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, unspecified eye Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, right eye Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, left eye Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral Other specified diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, unspecified eye Routine Foot Care Page 17 of 23

18 E E E E E E E E E E E E E Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, right eye Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, left eye Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, bilateral Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy with macular edema, unspecified eye Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, right eye Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, left eye Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, bilateral Other specified diabetes mellitus with severe nonproliferative diabetic retinopathy without macular edema, unspecified eye Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, left eye Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye Other specified diabetes mellitus with proliferative diabetic retinopathy with traction retinal detachment involving the macula, right eye Routine Foot Care Page 18 of 23

19 E E E E Other specified diabetes mellitus with stable proliferative diabetic retinopathy, bilateral Other specified diabetes mellitus with stable proliferative diabetic retinopathy, unspecified eye Other specified diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye Routine Foot Care Page 19 of 23

20 I Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot I Atherosclerosis of native arteries of right leg with ulceration of other part of foot I Atherosclerosis of native arteries of right leg with ulceration of other part of lower right leg I Atherosclerosis of native arteries of right leg with ulceration of unspecified site I Atherosclerosis of native arteries of left leg with ulceration of thigh I Atherosclerosis of native arteries of left leg with ulceration of calf I Atherosclerosis of native arteries of left leg with ulceration of ankle I Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot I Atherosclerosis of native arteries of left leg with ulceration of other part of foot I Atherosclerosis of native arteries of left leg with ulceration of other part of lower left leg I Atherosclerosis of native arteries of left leg with ulceration of unspecified site I70.25 Atherosclerosis of native arteries of other extremities with ulceration I Atherosclerosis of native arteries of extremities with gangrene, right leg I Atherosclerosis of native arteries of extremities with gangrene, left leg I Atherosclerosis of native arteries of extremities with gangrene, bilateral legs I Atherosclerosis of native arteries of extremities with gangrene, other extremity I Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity I I I I I I I I I I I I I I I Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of heel and midfoot Atherosclerosis of unspecified type of bypass graft(s) of the right leg with ulceration of other part of foot Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of heel and midfoot Atherosclerosis of unspecified type of bypass graft(s) of the left leg with ulceration of other part of foot Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of heel and midfoot Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of other part of foot Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of heel and midfoot Atherosclerosis of autologous vein bypass graft(s) of the left leg with ulceration of other part of foot Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of heel and midfoot Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of other part of foot Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of heel and midfoot Atherosclerosis of nonautologous biological bypass graft(s) of the left leg with ulceration of other part of foot Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of heel and midfoot Atherosclerosis of nonbiological bypass graft(s) of the right leg with ulceration of other part of foot Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of heel and midfoot Routine Foot Care Page 20 of 23

21 I I I I I L Atherosclerosis of nonbiological bypass graft(s) of the left leg with ulceration of other part of foot Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of heel and midfoot Atherosclerosis of other type of bypass graft(s) of the right leg with ulceration of other part of foot Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of heel and midfoot Atherosclerosis of other type of bypass graft(s) of the left leg with ulceration of other part of foot Non-pressure chronic ulcer of unspecified heel and midfoot limited to breakdown of skin L Non-pressure chronic ulcer of unspecified heel and midfoot with fat layer exposed L Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of muscle L Non-pressure chronic ulcer of unspecified heel and midfoot with necrosis of bone L Non-pressure chronic ulcer of unspecified heel and midfoot with unspecified severity L Non-pressure chronic ulcer of right heel and midfoot limited to breakdown of skin L Non-pressure chronic ulcer of right heel and midfoot with fat layer exposed L Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle L Non-pressure chronic ulcer of right heel and midfoot with necrosis of bone L Non-pressure chronic ulcer of right heel and midfoot with unspecified severity L Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin L Non-pressure chronic ulcer of left heel and midfoot with fat layer exposed L Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle L Non-pressure chronic ulcer of left heel and midfoot with necrosis of bone L Non-pressure chronic ulcer of left heel and midfoot with unspecified severity L Non-pressure chronic ulcer of other part of unspecified foot limited to breakdown of skin L Non-pressure chronic ulcer of other part of unspecified foot with fat layer exposed L Non-pressure chronic ulcer of other part of unspecified foot with necrosis of muscle L Non-pressure chronic ulcer of other part of unspecified foot with necrosis of bone L Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity L Non-pressure chronic ulcer of other part of right foot limited to breakdown of skin L Non-pressure chronic ulcer of other part of right foot with fat layer exposed L Non-pressure chronic ulcer of other part of right foot with necrosis of muscle L Non-pressure chronic ulcer of other part of right foot with necrosis of bone L Non-pressure chronic ulcer of other part of right foot with unspecified severity L Non-pressure chronic ulcer of other part of left foot limited to breakdown of skin L Non-pressure chronic ulcer of other part of left foot with fat layer exposed L Non-pressure chronic ulcer of other part of left foot with necrosis of muscle L Non-pressure chronic ulcer of other part of left foot with necrosis of bone L Non-pressure chronic ulcer of other part of left foot with unspecified severity Routine Foot Care and Nail Trimming, Cutting or Debriding B35.3 Tinea pedis L60.1 Onycholysis L60.2 Onychogryphosis L60.3 Nail dystrophy L60.4 Beau's lines Routine Foot Care Page 21 of 23

E08.621 Diabetes mellitus due to underlying condition with foot ulcer E09.621 Drug or chemical induced diabetes mellitus with foot ulcer E10.10 Type 1 diabetes mellitus with ketoacidosis without coma E10.11

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