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Anthem Blue Cross provides coverage for podiatry services when they are medically necessary and meet the plan guidelines. The coverage can be different depending on the plan, but most policies follow the same criteria for treatment eligibility in both commercial and Medicare Advantage products.
1.Foot care services such as cutting, removal of corns, or trimming, clipping, or debriding of nails are considered medically necessary when the following criteria are met:
(a) The person has a systemic condition that causes circulatory insufficiency of the lower extremity, including, but not limited to, one or more of these conditions:
(b) The person is at risk of infection or poor wound healing due to other medical conditions.
(c) Foot care services are not provided more frequently than once every 2 months.
2. Debridement of mycotic nails can be considered medically necessary when a person has:
(a) Pain that is unresponsive to conservative management, or
(b) Secondary infection that results from the thickening and dystrophy of the infected toenail plate, and
(c) Foot care services are not provided frequently
3. Surgical removal or care needed for treatment of an ingrown toenail is medically necessary.
Foot care services, including cutting or removal of corns or cutting, clipping, or debriding of nails, are considered not medically necessary when the criteria above are not met. Cleaning and soaking of the feet by a medical professional is considered not medically necessary.
Anthem Blue Cross plans are different, so we recommend that you bring your Anthem insurance card and contact us before you visit. We will help you know your coverage and any additional costs you need to bear.
