CPT® 11056: Paring or cutting of benign hyperkeratotic lesion, 2 to 4 lesions

In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.

This is to update providers of the claim review findings for CPT® 11056: Paring or cutting of benign hyperkeratotic lesion, 2 to 4 lesions. The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.

The Jurisdiction E, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 11056: Paring or cutting of benign hyperkeratotic lesion, 2 to 4 lesions The quarterly edit effectiveness results from April 1, 2025 through June 30, 2025, are as follows:

Top Denial Reasons

  • Denial Reason 1 - Failure to return records
  • Denial Reason 2 - Documentation incomplete and/or insufficient
  • Denial Reason 3 - Documentation does not support the modifiers billed

Educational Resources

Education

CPT® 11056 is reported for the parring or cutting of benign hyperkeratotic lesions, such as corns or callouses; 2 to 4 lesions.

Routine foot care, which includes the paring or cutting of corns and calluses, is not covered by Medicare unless the patient suffers from a condition that puts him/her at risk when these services are performed by a nonprofessional. Medicare requires the use of specific HCPCS Level II modifiers Q7-Q9 to indicate clinical findings indicative of severe peripheral involvement warranting the medical necessity of providing foot care, such as nail debridement or trimming, that would usually be considered routine and for which benefits would not be provided

If provided by a physician (M.D.) or a Medicare-certified podiatrist (doctor of podiatric medicine, or DPM), medically necessary care for treatment of injury, disease, or other medical conditions affecting the foot, ankle, or lower leg is covered by Medicare Part B. Routine foot care that's not medically necessary is not covered.

The presence of a systemic condition such as metabolic, neurologic, or peripheral vascular disease may require scrupulous foot care by a professional that in the absence of such condition(s) would be considered routine (and, therefore, excluded from coverage). Accordingly, foot care that would otherwise be considered routine may be covered when systemic condition(s) result in severe circulatory embarrassment or areas of diminished sensation in the individual's legs or feet. In these instances, certain foot care procedures that otherwise are considered routine (e.g., cutting or removing corns and calluses, or trimming, cutting, clipping, or debriding nails) may pose a hazard when performed by a nonprofessional person on patients with such systemic conditions. Please refer to the Internet-Only Manuals (IOM) Publication 100-02, Benefit Policy Manual, Chapter 15, Section 290 for a listing, although not all inclusive, of systemic conditions that may justify coverage.

Certain foot care related services are not generally covered by Medicare. In general, the following services, whether performed by a podiatrist, osteopath, or Doctor of Medicine, and without regard to the difficulty or complexity of the procedure, are not covered by Medicare:

  • Treatment of Flat Foot
  • Routine Foot Care
  • Supportive Devices for feet

Effective for services furnished on/after July 1, 2002, Medicare covers an evaluation (examination and treatment) of the feet no more often than every six months for individuals with a documented diagnosis of diabetic sensory neuropathy and LOPS, as long as the beneficiary has not seen a foot care specialist for some other reason in the interim.

The diagnosis of diabetic sensory neuropathy with Loss of Protective Sensation (LOPS) LOPS should be established and documented prior to coverage of foot care. Other causes of peripheral neuropathy should be considered and investigated by the primary care physician prior to initiating or referring for foot care for patients with LOPS. See the CMS Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy) (70.2.1) National Coverage Determination (NCD) for more information.

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