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 (eg, corn or callus); 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 (eg, corn or callus); 2 to 4 lesions. The quarterly edit effectiveness results from October 1, 2025, through December 31, 2025, are as follows:

Top Denial Reasons

• Denial Reason 1 - Failure to return records
• Denial Reason 2 - The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination
• Denial Reason 3 - The documentation submitted did not include a valid signature and a response to attestation or signature log request was not received

Educational Resources

• Failure to Return Records
• Documentation and Coding that Demonstrates Medical Necessity
• Podiatry
• LCD L38902 Wound and Ulcer Care
• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 290

Education

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.

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.

• Q7 Modifier: Applied when there is one major (Class A) foot condition, such as a foot amputation
• Q8 Modifier: Used for two moderate (Class B) foot problems, like poor circulation or skin changes.
• Q9 Modifier: Applied when there is a combination of one moderate (Class B) and two minor (Class C) foot findings, such as decreased sensation along with thick toenails.