Podiatry Insurance Coverage

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Totally Feet Podiatry and Laser Center offers a full array of podiatry and laser services in the office. Below is some vital information about insurance coverage and facilitating a smooth visit. It is important to understand some treatments are considered to be cosmetic and not covered by insurance. These are normally treatments associated with fungal nails, spider veins, or anything else considered cosmetic.

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Office Patients

Totally Feet Podiatry and Laser Center takes many different insurance plans, below is a list of most of the larger plans accepted:
¨ Medicare

¨ Medicaid

¨ Humana

¨ Cigna

¨ United Healthcare

¨ Evercare

¨ Secured Horizons

¨ Pacificare

¨ Aetna

¨ Colorado Access

Some services provided are not covered by insurance plans, these services shall be paid for at the time of service. These services include non-medically necessary procedures as they are dictated by your insurance company. It is a patients responsibility to understand what may or may not be covered at a visit. We accept credit cards, checks, and cash.

Facility Patients and Family members

When Dr. Oehler provides services to a resident he will need the following information for billing purposes.

· Copy of their resident information sheet which should include medical insurance information and the name, address and phone number of the person who financially responsible for the payment of any balance due.

· If you have a copy of their insurance card-a copy provided to us is always helpful.

· The residents medical insurance is billed for the services rendered.
· If the patient is responsible for a balance due per their insurance, a statement will be sent to the financial responsible party after the insurance company has made payment.

· Medicare will pay for the trimming of toenails (procedure code 11720 or 11721) every 62 days. If the patient still wants to be seen prior to the 62nd day, then Totally Feet is required to have the patient sign an ABN (Advanced Beneficiary Notice) stating that they are aware that Medicare will not cover the services and that they are going to be financially responsible.

Certificate of Medical Necessity (CMN)

Patient Information Form

Form CMS-R-131 ABN Advanced Beneficiary Notice

Notice of Exclusion of Medicare Benefits (NEMB)

· There are Medicare Advantage programs thru Anthem BCBS and Humana that Dr. Oehler accepts.

· Dr. Oehler is a participating provider with Colorado Medicaid.

· Denver Health Medical residents need to make sure that the services do not need to be pre-authorized.

· Kaiser will only cover the services if they have been pre-authorized with Kaiser. This needs to be done by the Kaiser PCP’s at the facility. Dr. Oehler will see the Kaiser residents and if Kaiser does not pay, then the patient is financially responsible.

· United Healthcare/Evercare/Secure Horizons / Pacificare-Dr. Oehler is a participating provider for the insurance carriers.

· Dr. Oehler is working on contracting with other insurance carriers.
Generally the initial visit will include an Evaluation and Management (E/M) code and then a procedure code(s) for the additional services rendered.

Medicare Coverage

Medicare and other insurances do cover foot care under very specific conditions. These conditions are spelled out explicitly in the Medicare Local Coverage Determinations (LCD’s).  Below you will find common LCD’s pertaining to conditions related to podiatry.
Medicare’s Explanation of Routine Foot Care

Medicare’s Routine Foot Care LCD (Federal Law)

Wound Care LCD (Federal Law)

Nerve Conduction Studies LCD (Federal Law)

Noninvasive Vasular Studies (NIVS) LCD (Federal Law)

Noninvasive Arterial Studies LCD (Federal Law)

Debridement Mycotic Nails LCD (Federal Law)

Surgical Treatment of Nails LCD (Federal Law)

Trigger Injection LCD (Federal Law)

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